Women's experience with breast biopsy

AORN Journal,  Nov, 2004  by Sharon L. Chappy

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An estimated 216,000 women will be diagnosed with breast cancer in 2004, and there will be approximately 40,110 breast cancer-related deaths. (1) (p4) Only 10% to 20% of all breast biopsies reveal malignancy; (2-4) therefore, one can surmise that approximately 1.08 million to 2.16 million breast biopsies will be performed in the United States in 2004. This number has increased significantly since 1997, when approximately 750,000 biopsies were performed. (5) (p473) Increased public awareness, as well as the increased availability and sensitivity of breast cancer screening and detection methods, likely contributed to this increase.

The emotional effects of the breast biopsy experience--no matter what the eventual pathology outcome--often start when the lesion first is detected and can extend long after the biopsy procedure. (2-4,6) Although the preoperative and postoperative phases of biopsy have been studied extensively, there is a paucity of research examining the intra-operative experiences of women undergoing the procedure.

BACKGROUND

Until recently, most breast biopsies were performed under general anesthesia, with patients arriving in the OR after receiving sedation. Pharmacological and technological advances have made it possible to safety perform most incisional and excisional breast biopsies in the United States on awake patients under local anesthesia without causing them discomfort. (7) During the past few years, stereotactic-guided breast biopsy has replaced more invasive techniques for the biopsy of many nonpalpable breast lesions detected on a mammogram. This technique is minimally invasive, is done with local anesthesia, and uses computerized imaging and mammography to pinpoint the location of the abnormality and then remove tissue specimens. (8-10)

Undergoing any type of invasive procedure can cause feelings of uncertainty and anxiety. Women have reported that their physicians did not prepare them adequately for the biopsy experience (5) and that they wanted more information from health care providers. (11,12) Being awake during a biopsy adds a dimension to the experience that is not an issue when general anesthesia is used. Women undergoing breast biopsies may have escalated feelings of uncertainty and anxiety both because subsequent diagnosis could require further surgery and because of the implications for sexuality and mortality. (6,13,14)

The anxiety that accompanies the discovery of a breast abnormality and diagnostic testing that occurs after discovery is well documented. (2,5,6,14-21) Research regarding breast biopsies, however, has dealt primarily with either the preoperative or postoperative phase. A 2001 study explored breast biopsy experiences in a sample of women who had general anesthesia. (2) Another study noted that qualitative investigation of the biopsy experience is long overdue. (21) No published studies address the surgical phase of biopsy. Perhaps this can be attributed to the newness of using local anesthesia for these procedures. Now that most biopsies are performed using local anesthesia, it is important to gain a better understanding of women's perceptions of the surgical phase of the biopsy process. (7)

METHODS

The purpose of this qualitative, descriptive study was to obtain descriptions of perioperative experiences from patients who underwent breast biopsies with local anesthesia at hospitals and outpatient clinics in the Midwestern United States. Participants described their experiences orally.

PROCEDURES. The Institutional Review Board for the Protection of Human Subjects at the University of Wisconsin Oshkosh, Wis, and three human participants protection service committees relevant to the participating sites approved the study. Fourteen physicians who performed breast biopsies in 11 different settings agreed to solicit study participants from their practices. After performing a breast biopsy with local anesthesia, the physician or a designated assistant informed patients about the study and asked permission to release their names to the researcher. The researcher then called all women who agreed to be contacted and explained the study.

SAMPLE. Sampling criteria included that participants must

* be at least 18 years of age,

* speak and understand English,

* be able to remember and describe the surgical phase of the biopsy, and

* give written, informed consent to participate.

If a patient met the sampling criteria and agreed to participate, an interview was scheduled.

The sample consisted of 22 women 19 to 82 years of age. Of these, 21 were white and one was black. Seventeen were married, two divorced, two widowed, and one single. For 16 of the women, lesions were discovered on mammography. Five women discovered lesions while performing breast self-examinations. A nurse discovered one woman's lesion during a clinical breast examination. Seven women had excisional biopsies, 14 had the stereotactic technique, and one had a core needle biopsy. Sixteen women had benign outcomes, six had malignant outcomes.