For the study, researchers from Beth Israel Deaconess Medical Center and Harvard Medical School followed 126 women through the waiting period after a breast biopsy, monitoring their levels of the stress hormone cortisol. The researchers reported that although the average wait time for results of a biopsy was about two-and-a-half days, some women had to wait five days or longer. The study found that after five days, 37 women were told their test results were benign, 16 women were told they had cancer and 73 women had not received their results. Most of the women who had not received their results by the fifth day were not given an explanation for the delay, according to the study. Cortisol levels of the women who had not received results were “essentially indistinguishable” from the levels found in women who were diagnosed with breast cancer, the study found. In addition, women who were still waiting for results also had significantly higher cortisol levels than the women who received benign test results.

According to Elvira Lang, associate professor of radiology at Harvard Medical School and lead author of the study, the findings are concerning because cortisol levels can influence wound healing and immune response that could raise a woman’s health risk if she ultimately needed cancer treatment. Lang added that the stress women experienced during the waiting period was detrimental to their overall quality of life. “If you talk to any woman who has had to wait for results, she will tell you it’s a horrible roller coaster,” Lang said, adding, “Even when patients hear they have a cancer, they can start doing something. But if you hang in there for five days and you still don’t know what direction it goes, it’s just very stressful.”

Lang added that the study should increase awareness about the need for hospitals to shorten the waiting periods for test results, improve communication with patients waiting for results and possibly offer psychological services to women during the waiting period. “We have to work much faster to get results to women,” Lang said, adding, “You want to keep stressors as profound as this as short as possible.” The study was financed by the Department of Defense breast cancer research program. According to the Times, Lang noted a financial interest in a consulting firm that provides health workers with training on how to improve patient communication (Parker-Pope, New York Times, 2/25).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

“When women express how taxing it is to have to wait for results, the medical establishment may dismiss their feelings as psychological,” said the study’s lead author, Elvira V. Lang, M.D., associate professor of radiology at Harvard Medical School and radiologist at Beth Israel Deaconess Medical Center in Boston. “We were able to show that this state of not knowing the diagnosis goes along with biochemical changes which can have adverse effects on wound healing and the immune system.”

More than 1.2 million breast biopsies are performed in the U.S. annually, with 80 percent resulting in non-cancerous findings, according to the American Cancer Society. Women experience considerable anxiety while waiting to undergo breast biopsy and while waiting for the results. Dr. Lang and colleagues sought to establish a biochemical marker to assess the physical effects associated with the stress of extended waiting for a final diagnosis after breast biopsy.

For this study, the researchers used cortisol samples collected from the saliva of 126 women during an earlier clinical trial on patient stress during biopsy. Cortisol is a hormone produced by the adrenal gland and is often referred to as the “stress hormone.” The production of cortisol is part of the body’s natural response to stress. Stress-induced imbalances in cortisol secretion have been associated with impairments to immune response and wound healing.

“Cortisol helps us fight acute stress by adjusting blood pressure, blood sugar and immune response in a good way when needed,” Dr. Lang said. “But when stress becomes chronic, cortisol secretion either goes into continuous overdrive or dries up, leaving the immune system vulnerable and other body functions less well adapted.”

The women participating in the study underwent large-core breast biopsy and learned their diagnosis one to six days after the procedure. Salivary cortisol samples were collected on cotton swabs on the day of biopsy and each of the four days following biopsy.

During the period in which the samples were taken, the women learned whether their biopsy results were benign (non-cancerous), malignant (cancerous) or uncertain. By the fourth day after biopsy, 16 patients had learned they had cancer, 37 patients had benign findings and 73 patients had an uncertain diagnosis, because their results had not been communicated yet or they required further diagnostic procedures.

The results showed that cortisol secretion for the women with uncertain results was significantly different than that of the women with benign results and highly similar to secretion levels in the women with malignant results.

The researchers hope that these findings will encourage faster analysis and communication of biopsy results. They counsel women to speak to their doctors about communication procedures before undergoing breast biopsy.

“Women should ask who will communicate their results to them and how long it will take to receive them,” Dr. Lang said. “Then they should schedule the biopsy accordingly, taking into account delays over weekends and holidays.”

“It is no longer so easy for healthcare providers to overlook the effects of extended waiting and say ‘Oh, it’s just nerves,’” she added.

For patient-friendly information on breast biopsy, visit RadiologyInfo.org.

“Large-Core Breast Biopsy: Abnormal Salivary Cortisol Profiles Associated with Uncertainty of Diagnosis.” Collaborating with Dr. Lang were Kevin S. Berbaum, Ph.D., and Susan K. Lutgendorf, Ph.D.

Radiology is edited by Herbert Y. Kressel, M.D., Harvard Medical School, Boston, Mass., and owned and published by the Radiological Society of North America, Inc. (RSNA.org/radiologyjnl)

RSNA is an association of more than 42,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. (RSNA.org)

According to Temple University’s Joanna Maselko, Sc.D., women who had stopped being religiously active were more than three times more likely to have suffered generalized anxiety and alcohol abuse/dependence than women who reported always having been active.

“One’s lifetime pattern of religious service attendance can be related to psychiatric illness,” said Maselko, an assistant professor of public health and co-author of the study, which appears in the January issue of Social Psychiatry and Psychiatric Epidemiology.

Conversely, men who stopped being religiously active were less likely to suffer major depression when compared to men who had always been religiously active.

Maselko offers one possible explanation for the gender differences in the relationship between religious activity and mental health.

“Women are simply more integrated into the social networks of their religious communities. When they stop attending religious services, they lose access to that network and all its potential benefits. Men may not be as integrated into the religious community in the first place and so may not suffer the negative consequences of leaving,” Maselko said.

The study expands on previous research in the field by analyzing the relationship between mental health – anxiety, depression and alcohol dependence or abuse – and spirituality using current and past levels, said Maselko, who conducted the research when she was at Harvard University.

In the study sample, comprising 718 adults, a majority of men and women changed their level of religious activity between childhood and adulthood, which was critical information for the researchers.

“A person’s current level of spirituality is only part of the story. We can only get a better understanding of the relationship between health and spirituality by knowing a person’s lifetime religious history,” Maselko said.

Out of the 278 women in the group, 39 percent (N=109) had always been religiously active and 51 percent (N=141) had not been active since childhood. About 7 percent of the women who have always been religiously active met the criteria for generalized anxiety disorder compared to 21 percent of women who had stopped being religiously active.

“Everyone has some spirituality, whether it is an active part of their life or not; whether they are agnostic or atheist or just ‘non-practicing.’ These choices potentially have health implications, similar to the way that one’s social networks do,” Maselko said.

Each of the elements of the two holiday inspired specials were chosen for their symbolic meaning and their therapeutic nature. Combined with the centuries old medicinal treatments of mud, hydrotherapy and healing touch, the treatments are ideal for extending the benefits of personal spa breaks scattered throughout the holiday season.

The Winter Solstice Special includes a mud bath, mineral bath with ginger, almond and cinnamon essential oils and the celestial aromatherapy massage. It was created to assist the entire body to cleanse and detoxify from holiday period excesses, as individual muscles and joints are soothed and comforted. The Glowing Holiday Special includes a hydrotherapy mineral bath with orange, cinnamon and clove essential oils, a mud bath and a holiday scented aromatherapy massage. The treatment includes an additional 25-minute foot and hand massage to revive feet weary from shopping and hands tired from wrapping and assembling presents. The entire treatment was developed as a necessary relaxation break that prepares the body and mind to healthfully enjoy holiday parties. Both treatments include a warm festive beverage upon arrival at the spa and a special holiday spa gift that will help extend the benefits of the experience.

The treatments, developed by a registered nurse and a professional massage therapist, are available through the end of the year at the Calistoga Oasis Spa. Located at 1300 Washington Street in Calistoga, the spa is known for retaining the highest quality spa therapists in the area and as one of only two Calistoga spas that specializes in providing couples with adjoining mineral and mud baths.

And yet despite this, almost half (45 per cent) of employers believe that none of their staff has any mental ill health issues at all, and a staggering 80 per cent of directors admit their company has no policy to deal with stress and mental ill health in the workplace.

The competitive long hours culture in Britain’s workplaces is taking its toll, with around 1 in 6 workers rating their job as ‘very’ or ‘extremely’ stressful. Work-related mental ill health not only has a devastating effect on families and personal relationships, but is also inextricably linked with physical wellbeing. And this can often be just the start of a person’s problems, with those returning to work after mental health-related sickness absence very often stigmatised and discriminated against – just 37 per cent of employers said they would consider employing someone who had a mental health problem.

The FPH statement, however, highlights that employers can do a great deal to protect and improve the mental health of their workforce. It calls on employers to both identify and reduce organisational causes of stress in their workplace, by consulting and working in partnership with staff and their representatives. They must also make sure robust policies are in place to protect staff from bullying and discrimination based on issues like race, sex, disability or sexual orientation and ensure that staff feel able to report incidents when they occur. They should also take measures to raise awareness of mental health issues among their workforce as a whole and make sure that managers are properly trained in recognising and addressing them.

‘Employers have statutory responsibilities to ensure the wellbeing of their staff and their mental health is a key part of that,’ said FPH President, Prof Alan Maryon-Davis. ‘By putting some very simple measures in place they can not only ensure a healthier workforce but also save money and boost their productivity. As is so often the case in public health, the people in the best position to make a difference are not necessarily those in the health service, but people in the boardroom, in offices and on the shopfloor who very often may not even realise the enormous contribution they can make.’

‘We hope this position statement will highlight the scale of the problem and raise awareness of solutions,’ said statement author Dr Jenny Bywaters, Senior Public Mental Health Adviser at the National Institute for Mental Health in England, and chair of the FPH’s Mental Health Working Group. ‘There is so much that can be done in the workplace to reduce stress and to help people cope with the unavoidable pressures of life. This means better health for staff and lower costs for employers and taxpayers – a real win-win for everyone.’

Notes:

1. The Faculty of Public Health recognises that mental health is a major public health issue. Mental health and work – a position statement is the first of a series of statements that we will be issuing on mental health issues over the next few months. A copy of the statement is attached to this email and will also be available from the FPH website here from 8.30am on Tuesday 27th November.

2. The Faculty of Public Health is the leading professional body for public health specialists in the UK. It aims to promote and protect the health of the population, and improve health services, by maintaining professional and educational standards, advocating on key public health issues, and providing practical information and guidance for public health professionals.

References:

According to Mental Health: Britain’s Biggest Social Problem (Prime Minister’s Strategy Unit, 2004) the total economic cost of common mental health problems is £25bn, made up of £13bn in lost output and time off sick, £8bn public services expenditure and £4bn carers’ time.

According to Mental health – the last workforce taboo (Shaw Trust, 2006), 45 per cent of employers thought none of their staff would be suffering from any form of mental ill health

One in six of all working people report that their job is either ‘very’ or ‘extremely’ stressful – Health and safety statistics 2005/06 (Health and Safety Commission, 2006).

Only 37 per cent of employers would consider employing someone with a mental health problem – Recruiting benefit claimants – a survey of employers in ONE pilot areas (DWP 2001)

“We found that different parts of the brain activate with different spatial and temporal profiles for men and women when they are faced with performance-related stress,” says J.J. Wang, PhD, Assistant Professor of Radiology and Neurology, and lead author of the study.

These findings suggest that stress responses may be fundamentally different in each gender, sometimes characterized as “fight-or-flight” in men and “tend-and-befriend” in women. Evolutionarily, males may have had to confront a stressor either by overcoming or fleeing it, while women may have instead responded by nurturing offspring and affiliating with social groups that maximize the survival of the species in times of adversity. The “fight-or-flight” response is associated with the main stress hormone system that produces cortisol in the human body — the hypothalamic-pituitary-adrenal (HPA) axis.

Thirty-two healthy subjects — 16 females and 16 males — received fMRI (functional Magnetic Resonance Imaging) scans before, during and after they underwent a challenging arithmetic task (serial subtraction of 13 from a 4 digit number), under pressure. To increase the level of stress, the researchers frequently prompted participants for a faster performance and asked them to restart the task if they responded incorrectly. As a low stress control condition, participants were asked to count backward without pressure.

The researchers measured heart rate, cortisol levels (a stress hormone), subjects’ perceived stress levels throughout the experiments, and regional cerebral blood flow (CBF), which provides a marker of regional brain function. In men, it was found that stress was associated with increased CBF in the right prefrontal cortex and CBF reduction in the left orbitofrontal cortex. In women, the limbic system — a part of the brain primarily involved in emotion — was activated when they were under stress. Both men and women’s brain activation lasted beyond the stress task, but the lasting response in the female brain was stronger. The neural response among the men was associated with higher levels of cortisol, whereas women did not have as much association between brain activation to stress and cortisol changes.

“Women have twice the rate of depression and anxiety disorders compared to men,” notes Dr. Wang. “Knowing that women respond to stress by increasing activity in brain regions involved with emotion, and that these changes last longer than in men, may help us begin to explain the gender differences in the incidence of mood disorders.”

Dr. Cheryl Dellasega, professor of humanities and women’s studies in Penn State’s College of Medicine, examines the even harsher reality of female family feuds — sisters who sabotage, ex-wives who wage subtle warfare, and other family situations where women emotionally wound each other in her new book “Forced to Be Family: A Guide for Living with Sinister Sisters, Drama Mamas, and Infuriating In-Laws.”

She offers clinical insights and real-life stories to explain why these female family antagonisms have a special power to hurt and offers practical strategies to help restore relationships and reclaim lives.

“Going home for the holidays” If so, you may witness versions of gossip, exclusion and other hurtful behaviors: the meddling mother who can’t believe your son dropped out of college, or the sinister sister-in-law locked in competition to prove her children are brighter, smarter, better behaved, and more attractive than yours,” says Dellasega. “In my work with women caught up in the maelstrom of relational aggression, some of the most emotional-and intractable-stories I hear involve female relatives.”

Dellasega has conducted research on female relationship issues and relationship aggression, a form of bullying by girls and women. Her books are: “Mean Girls Grown Up,” “Surviving Ophelia: Mothers Share Their Wisdom in Navigating the Tumultuous Teenage Years,” “The Starving Family” and “Girl Wars: Twelve Tried and True Strategies for Ending Adolescent Aggression.”

Female family feuds involve a special brand of Relative “RA” (relational aggression) that can hurt more than the barbs of a seventh grade girl ever did, according to the researcher.

“After all, your relatives are supposed to love you unconditionally — what does it say about you if they don’t?” she notes. “There’s all the potential ammunition they have against you, including the gritty details of your disastrous first marriage and the times your children behaved badly, especially in 1990 when your firstborn broke your mother’s priceless glass figurine.”

The drive to preserve family ties, even when those connections aren’t so positive, is called kin keeping. No matter what disputes arise among those in attendance, the show will go on as it has for generations.

To ease stress and anxiety prior to the holidays, the Penn State researcher suggests creating a plan that circumvents female family feuds: review and revise your expectations; take a look at your own behavior and avoid triggering aggression; avoid too much food, alcohol and togetherness; keep the focus away from yourself; and remember that the holiday will end soon.

However, Dr. Dellasega believes in the best of women and girls, noting, “It’s a stereotype to say women are naturally mean. If anything, we long to connect and have positive relationships, especially with female family members.”