Persistent Breast Pain Following Breast Cancer Surgery Is Associated With Persistent Sensory Changes, Pain Interference, and Functional Impairments
Dale J. LangfordSteven M. PaulClaudia WestJon D. LevineDeborah HamolskyCharles ElboimBrian L. SchmidtBruce A. CooperGary AbramsBradley E. AouizeratChristine Miaskowski
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Sir: We read with interest the article by Cogwell Anderson et al.,1 which describes the validation of the Breast Evaluation Questionnaire. To appropriately measure the effectiveness of breast surgery, well-developed and validated patient questionnaires are clearly required.2 The authors should be congratulated for presenting the psychometric properties of the Breast Evaluation Questionnaire. To understand all aspects of outcome and to accurately measure change brought about by surgical intervention, questionnaires developed uniquely for breast surgery patients are essential.2 To take this a step further, a useful questionnaire not only should be breast surgery–specific but should also focus on a specific type of breast surgery, whether it be breast augmentation, reduction, or reconstruction. While patients in these different treatment groups have a clear common ground, it does not necessarily follow that they share all the same outcomes of interest. In qualitative interviews we conducted recently with 48 patients undergoing these three different types of breast surgery, we found that the groups often had different concerns. For example, physical function was much more relevant to breast reduction patients, whereas perception of symmetry was more important to augmentation patients.3,4 A questionnaire developed and tested only among cosmetic breast augmentation patients cannot be assumed to adequately measure all the unique concerns of, for example, mastectomy or breast trauma patients. Thus, we question the authors' recommendation that the Breast Evaluation Questionnaire be used for "assessing outcomes among breast augmentation patients, breast reconstruction patients, mastectomy patients, lumpectomy/breast-sparing surgery patients, breast reduction patients, and patients who have sustained trauma or injury to their breasts." To draw such conclusions, one would ideally develop a questionnaire with input from all these various patient groups. Such input helps to generate questions that are most relevant and important to the targeted patients. In addition, the questions should take into consideration the patients' perspectives using language that they understand. Unfortunately, the authors do not report on the development of the Breast Evaluation Questionnaire, so we do not know which patients' concerns are represented in their instrument or if the concerns were derived from surgeons rather than the patients themselves. An alternate but less optimal approach would be to examine how the Breast Evaluation Questionnaire performs in these diverse patient groups. The current study, however, addresses the validity of the Breast Evaluation Questionnaire only among breast augmentation patients; it does not provide support for the validity of the measure among other patient groups. It is important to adopt the optimal approach for measuring patient satisfaction and quality of life in cosmetic and reconstructive breast surgery patients, so that new studies will have a meaningful basis from which to compare surgical results. We need to ensure that the evidence that we use to make these comparisons is of the highest possible quality. This requires use of not only good study design but also good measurement tools (i.e., questionnaires). Patient-reported outcome questionnaires should ideally undergo full development and validation, as outlined by the Scientific Advisory Committee of the Medical Outcomes Trust5 and most recently by the U.S. Food and Drug Administration.6 To adequately demonstrate the benefits of cosmetic and reconstructive breast surgery, future research is needed to rigorously develop and validate new procedure-specific questionnaires.7 Such new measures will provide surgeons with important tools to support research efforts, clinical practice improvement, and advocacy. Andrea L. Pusic, M.D., M.H.S. Memorial Sloan-Kettering Cancer Center New York, N.Y. Anne Klassen, Ph.D. University of British Columbia Vancouver, British Columbia, Canada Stefan J. Cano, Ph.D. Institute of Neurology University College London London, United Kingdom Carolyn L. Kerrigan, M.D. Dartmouth Hitchcock Medical Center Lebanon, N.H.
Lumpectomy
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Objectives: This study compared persistent breast pain among women who received breast-conserving surgery for breast cancer and women without a history of breast cancer. Methods: Breast cancer survivors (n=200) were recruited at their first postsurgical surveillance mammogram (6 to 15 mo postsurgery). Women without a breast cancer history (n=150) were recruited at the time of a routine screening mammogram. All women completed measures of breast pain, pain interference with daily activities and intimacy, worry about breast pain, anxiety symptoms, and depression symptoms. Demographic and medical information were also collected. Results: Persistent breast pain (duration ≥6 mo) was reported by 46.5% of breast cancer survivors and 12.7% of women without a breast cancer history ( P <0.05). Breast cancer survivors also had significantly higher rates of clinically significant persistent breast pain (pain intensity score ≥3/10), as well as higher average breast pain intensity and unpleasantness scores. Breast cancer survivors with persistent breast pain had significantly higher levels of depressive symptoms, as well as pain worry and interference, compared with survivors without persistent breast pain or women without a breast cancer history. Anxiety symptoms were significantly higher in breast cancer survivors with persistent breast pain compared with women without a breast cancer history. Discussion: Results indicate that persistent breast pain negatively impacts women with a history of breast-conserving cancer surgery compared with women without that history. Strategies to ameliorate persistent breast pain and to improve adjustment among women with persistent breast pain should be explored for incorporation into standard care for breast cancer survivors.
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Reduction Mammoplasty
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Білім берy қоғaмның экономикaлық дaмyының негізі, әлеyметтік тұрaқтылықтың фaкторлaрының бірі, хaлықтың рyхaни-aдaмгершілік әлеyетінің және интеллектyaлдық өсyінің қaйнaр көзі ретінде бaрлық yaқыттaрдa тaптырмaс құндылық болып есептеліп келеді. Aл қaзіргідей aдaм кaпитaлын қaлыптaстырy мен дaмытy мәселесін шешy негізгі міндет ретінде қaрaстырылaтын зaмaндa хaлықтың білімдік қaжеттіліктері өсіп, жоғaры, ортa aрнayлы, кәсіби қосымшa білім aлyғa үміткерлер сaны aртa түсyде. Бұғaн жayaп ретінде білім берy ұйымдaрының сaлaлaнyы aртып, әртүрлі типтегі оқy орындaрының сaны aртyдa, білім берyдің инфрaқұрылымы, бaсқaрy формaлaры, әдістемелік, ғылыми қызмет түрлері дaмyдa. Олaрды білім aлyшылaрдың жеке сұрaныстaры мен мүмкіндіктеріне бaғыттay күшейтілyде. Осығaн орaй білімнің сaпaсынa қойылaтын тaлaптaр aртып, бұл сaлaның әлеyметпен өзaрa әрекеттестігіне негізделген құрылымдық – қызметтік дaмyының көкейтестілігі aртyдa. Мaқaлaдa «серіктестік», «әлеyметтік серіктестік», «білімдегі әлеyметтік серіктестік» ұғым- дaрының мәні aшылып, олaрдың қaлыптaсy және дaмy үрдісіне шолy жaсaлaды, жоғaры оқy орындaрындa педaгогтaрды дaярлayдa әлеyметтік серіктестердің әлеyетін пaйдaлaнyдa бaсшылыққa aлынaтын ұстaнымдaр мен тиімді жолдaры сипaттaлaды. Түйін сөздер: серіктестік, әлеyметтік серіктестік, білімдегі әлеyметтік серіктестік, бірлескен әрекет ұстaнымдaры, әлеуметтік серіктестік әлеуеті. Обрaзовaние является основой экономического рaзвития обществa, одним из фaкторов социaль- ной стaбильности, источником дyховно-нрaвственного потенциaлa и интеллектyaльного ростa людей и во все временa считaлось незaменимой ценностью. И в нaстоящее время, когдa решение проблемы формировaния и рaзвития человеческого кaпитaлa рaссмaтривaется кaк основнaя зaдaчa, рaстyт обрaзовaтельные потребности людей, yвеличивaется количество желaющих полyчить высшее, среднее, специaльное, профессионaльное дополнительное обрaзовaние. В ответ нa это yсиливaется рaзветвленность обрaзовaтельных оргaнизaций, yвеличивaется количество обрaзовaтельных оргaни- зaций рaзличного типa, рaзвивaются инфрaстрyктyрa обрaзовaния, формы yпрaвления, методическaя и нayчнaя деятельность. Yсиливaется их ориентaция нa индивидyaльные потребности и возможности обyчaющихся. В связи с этим повышaются требовaния к кaчествy обрaзовaния, возрaстaет знaчение стрyктyрно-фyнкционaльного рaзвития этой сферы нa основе взaимодействия с обществом. В стaтье рaскрывaется знaчение понятий «пaртнерство», «социaльное пaртнерство», «социaльное пaртнерство в обрaзовaнии», рaссмaтривaется процесс их стaновления и рaзвития, описывaются рyко- водящие принципы и эффективные способы использовaния потенциaлa социaльных пaртнеров в подготовке педaгогических кaдров в высших yчебных зaведениях. Ключевые словa: партнерство, социaльное пaртнерство, социaльное пaртнерство в обрaзовaнии, принципы совместного действия, поненциал социального партнерство. Education is the basis of the economic development of society, one of the factors of social stability, a source of spiritual and moral potential and intellectual growth of people and has always been considered an irreplaceable value. And at the present time, when the solution of the problem of the formation and development of human capital is considered as the main task, the educational needs of people are growing, the number of people wishing to receive higher, secondary, special, professional additional education is increasing. In response to this, the branching of educational organizations is increasing, the number of educational organizations of various types is increasing, the infrastructure of education, forms of management, methodological and scientific activities are developing. Their focus on the individual needs and capabilities of students is increasing. In this regard, the requirements for the quality of education are increasing, the importance of the structural and functional development of this sphere on the basis of interaction with society is increasing. The article reveals the meaning of the concepts of "partnership", "social partnership", "social partnership in education", examines the process of their formation and development, describes the guidelines and effective ways to use the potential of social partners in the training of teachers in higher educational institutions. Keywords: partnership, social partnership, social partnership in education, principles of joint action, the potential of social partnership.
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Cosmetic breast surgery is commonly performed in the United States; 520,000 procedures of the total 1.8 million cosmetic surgical procedures performed in 2018 were breast related. Postoperative chronic pain, defined as lasting 3 or more months, has been reported in a wide variety of breast surgical procedures including breast augmentation, reduction mammaplasty, mastectomy, and mastectomy with reconstruction. Patient characteristics associated with the development of postoperative chronic pain following cosmetic breast surgery include a younger age, larger BMI, smaller height, postoperative hyperesthesia, and elevated baseline depression, anxiety, and catastrophizing scores. The anatomical distribution of chronic pain following breast augmentation procedures is dependent upon incision site placement; pectoral and intercostal nerves have been implicated. The purpose of this review is to provide an update on the current literature addressing the pathophysiology, clinical presentation, and treatment of patients presenting with chronic postoperative pain following cosmetic breast surgery. A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms "cosmetic surgery", "breast surgery", "postoperative pain", and "chronic pain". Cosmetic breast surgery can have a similar presentation as post-mastectomy pain syndrome and thus have overlapping diagnostic criteria. Seven domains are identified for a diagnosis of PBSPS: Pain after breast surgery, neuropathic in nature, at least a moderate intensity of pain, as defined as within the middle one-third of the selected pain scale, pain for at least 6 months, symptoms occurring for 12 or more hours a day for a minimum of 4 days each week, pain in at least one of the following sites: breast, chest wall, axilla, or arm on the affected side, pain exacerbated by movement. Patient risk factors and surgical risk factors may influence the development of chronic post-cosmetic surgery breast pain. Improved perioperative analgesia including preoperative regional nerve anesthesia and postoperative catheter infusion have been shown to improve chronic postoperative pain outcomes. The present review provides a discussion of clinical presentation, pathophysiology, and treatment and preventative strategies for chronic breast pain following cosmetic surgery. This review provides evidence from multiple randomized controlled trials (RCTs) and systematic reviews of efficacy and effectiveness. While chronic postoperative breast pain remains challenging to treat, various preventative strategies have been described to improve postoperative pain outcomes.
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Abstract Background: Mastalgia, breast pain without other signs or symptoms, is a very common complaint, yet occurs in only approximately 5% of patients with breast cancer. Most clinicians are aware of this lack of association with cancer. Mastalgia is also a common complaint after breast cancer treatment. This symptom is very worrisome to many women, and when seen in the office, clinicians tend to give in to the fear of patients and order various tests. In 2017, we presented an abstract at SABCS that showed that breast pain was not associated with breast cancer diagnosis. Many attendees were interested in the incidence of breast pain after breast cancer treatment. The current study was performed to evaluate the incidence and significance of mastalgia after breast cancer treatment. Methods: Maricopa Medical Center, the county safety net hospital in Phoenix, Arizona serves a patient base which is 34.5% non-English speaking. The majority of these patients are uninsured or underinsured. A total of 1635 breast cancer patients were seen at least once at the Breast Clinic from June 1, 2006 to December 31, 2018. Sociodemographic variables were collected on all patients. All patients who were treated for breast cancer and then presented with a complaint of breast pain during follow up were evaluated. Additionally, all patients who complained of a breast mass but were found to have pain with no mass were evaluated in a similar fashion. Results: A total of 1577 patients were seen during the time period. The mean age of the patients was age 52. Of the patients, 144 presented with or developed metastatic disease prior to their operation. 116 patients transferred their care to another facility. Of the remaining patients, 36% of patients (474 of 1317) presented with a complaint of breast pain during their follow up after breast cancer treatment. Of the patients with breast pain, 16 had an ipsilateral breast tumor recurrence or contralateral breast cancer diagnosis, however, none of the patients presented with breast pain. The breast pain occurred after treatment was completed. Nine patients presented with a palpable mass and seven patients presented with abnormal imaging. In contrast, 6.0% patients (51 of 843) without breast pain developed an ipsilateral breast tumor recurrence, chest wall recurrence, or contralateral breast cancer. 35 patients presented with a painless breast mass and the remaining 26 recurrences or contralateral breast cancer were found on routine imaging. Local recurrence or contralateral breast cancer were more common in patients without breast pain during follow up (p = 0.036). The two most common factors related to any breast cancer recurrence and death were noncompliance with recommended treatment and presentation with T4 (Stage 3B) breast cancer. Conclusions: Mastalgia is a very common complaint in patients seen for follow up after breast cancer treatment. Patients and providers may believe a complaint of breast pain warrants further workup and often results in additional, repeat, or interval imaging. With normal physical examination and routine imaging, however, breast pain alone does not appear to be an indication of breast cancer recurrence. Additional or repeat imaging as well as laboratory tests do not appear beneficial in patients with breast pain. Reassurance and patient education is necessary to avoid continued use of unnecessary medical resources. Citation Format: Ian Komenaka, Anushi Shah, Tina Wong, Daniela Cocco, Chiu-Hsieh Hsu, Jesse Nodora, Waqas Arslan, Maria Elena Martinez. Breast pain is a common complaint after breast cancer treatment but not a sign of recurrence [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-17-10.
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Purpose: Cosmetic breast augmentation procedures are commonly performed breast device surgeries. The Australian Breast Device Registry (ABDR) administers a five-question patient reported outcome measure (PROM), the BREAST-Q Implant Surveillance module (BREAST-Q IS), to patients 1, 2 and 5 years after breast device surgery. The measure includes an open-ended question to add any comments. This study aimed to use the responses to this open-ended question to assess participants' experiences of breast devices 1 and 2 years after breast augmentation. The secondary objective was to identify emerging and important issues relating to breast augmentation and devices. Patients and Methods: This qualitative descriptive study was conducted using a randomly selected sample of 268 responses to the open-ended question in the BREAST-Q IS, from the ABDR database. These responses were from patients who underwent breast augmentation between 2015 and 2018. Comments were analyzed using conventional content analysis in NVivo 12. Results: Four major themes were identified: satisfaction following breast augmentation, dissatisfaction following breast augmentation, complications and breast symptoms following breast augmentation and other comments. Two dominant themes were regarding satisfaction (n = 112) with overall surgical outcome, medical team, and post-operative appearance and complications and breast symptoms (n = 177) following breast augmentation. Emerging issues identified were rippling of breast implants and breast implant illness (BII). Conclusion: PROMs can be used to understand patients' perspectives on various aspects of their own surgical experiences. Participants provided responses regarding complications and breast symptoms experienced, and rippling of the breast implants and BII are emerging issues after breast augmentation. Keywords: patient reported outcome measures, breast augmentation, Breast-Q Implant Surveillance, breast device surgery, Australian Breast Device Registry
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