Abstract
BackgroundTo date, the study of the risks and benefits of breast cancer screening has not included the onset of persistent pain after breast cancer treatment within the context of population-based screening programs. Our purpose was to investigate the prevalence of persistent pain and associated factors in women diagnosed with breast cancer (screening or interval) in the context of a population-based breast cancer screening program in Spain.MethodsA total of 1,057 women participating in a population-based breast cancer screening program were diagnosed with breast cancer between 2000 and 2008. The women were treated surgically and followed-up to 2013. The risk of developing persistent pain was estimated through multivariate logistic regression analysis.ResultsBreast cancer was detected during routine screening in 732 women (69.3 %) and emerged as an interval cancer between two screening rounds in 325 (30.7 %). Persistent pain was present in 118 women (11.3 %). Women diagnosed through routine screening reported a higher prevalence of persistent pain (12.9 %) than those with interval cancers (7.8 %)(P < 0.05). Multivariate logistic regression analysis identified two other variables associated with persistent pain: having a Charlson index > =2 (Odds Ratio [OR]: 4.5 95 % Confidence Interval [CI]: 2.1-9.5) versus no comorbidities, and having undergone an axillary lymph node dissection (OR: 2.0 95 % CI: 1.0-4.0) versus sentinel lymph node biopsy.ConclusionsThe prevalence of persistent pain was relatively low. The detection mode was not related to the onset of persistent pain. The factors associated with persistent pain were a Charlson index > =2 and the performance of axillary lymph node dissection. Women treated for breast cancer are at risk for developing persistent pain regardless of the detection mode, especially those with comorbidities and those who have undergone axillary lymph node dissection.
Highlights
To date, the study of the risks and benefits of breast cancer screening has not included the onset of persistent pain after breast cancer treatment within the context of population-based screening programs
We aimed to investigate the prevalence of persistent pain and associated factors in women diagnosed with breast cancer in the context of a population-based breast cancer screening program in Spain
Breast cancer was detected during routine screening mammograms in 732 women (69.3 %) and emerged as interval cancer in 325 (30.7 %)
Summary
The study of the risks and benefits of breast cancer screening has not included the onset of persistent pain after breast cancer treatment within the context of population-based screening programs. Our purpose was to investigate the prevalence of persistent pain and associated factors in women diagnosed with breast cancer (screening or interval) in the context of a population-based breast cancer screening program in Spain. Women with interval cancer (cancers detected clinically after a negative screening round and before the following screening invitation) may not benefit from early detection because of a delay in diagnosis and less favourable biological tumor characteristics [3]. Several factors have been associated with the risk of developing persistent pain: young age [5,6,7, 10, 12, 14, 16, 17] adjuvant therapies (chemotherapy or radiotherapy) [5, 11], axillary lymph node dissection (ALND) [5,6,7, 10, 12], and the presence of comorbidities [5, 16], among others, but the evidence remains inconclusive
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