Posted 11.26.2018 | by AMRA

About one in eight U.S. women will be diagnosed with breast cancer at some point in their lives. Cancer is often diagnosed by a stereotactic breast biopsy that uses a mammography-guided needle to extract suspicious tissue. The procedure requires women to remain immobile for 15-30 minutes while undergoing breast compression, which can be an uncomfortable, anxiety provoking experience.

Patients can take prescription drugs to reduce anxiety, but this requires them to be driven to and from the procedure and can delay their return to work. As a result, there is interest in non-drug interventions to reduce biopsy discomfort and anxiety.

Ratcliff et al. [Journal of the American College of Radiology] compared the effect of mindfulness meditation or focused breathing to a control group on breast biopsy pain and anxiety.

The researchers randomly assigned 76 women (average age = 55 years; 74% Caucasian and 20% Hispanic/Latina) preparing to undergo stereotactic breast biopsy to: 1) a 10-minute guided mindfulness meditation, 2) a 10-minute guided period of focused diaphragmatic breathing, or 3) a 10-minute period of listening to a neutral audio clip.

Mindfulness meditation emphasized nonjudgmental observation of the breath, sensations, thoughts, and feelings with reminders to refocus whenever the mind wandered. The meditation was guided in-person by a mind-body medicine specialist. The specialist also accompanied the patient to the biopsy, coaching them in meditation during the procedure. Focused breathing was taught and coached similarly. Audio clip patients were not accompanied or coached during the biopsy.

Measures of anxiety and pain were taken after the training interventions, every four minutes during the biopsy, and immediately following the biopsy. Additionally, an electroencephalogram (EEG) measured patient brain wave activity in regions of interest before, during, and after the biopsy.

The mindfulness group showed a significantly greater reduction in anxiety during the biopsy than the focused breathing group (Cohen’s d = 0.48) or the audio clip control (d = 0.45). Reported pain levels did not significantly differ across groups. Although mindfulness reduced anxiety more than focused breathing, a significantly greater percentage of focused breathing participants rated their intervention as useful or very useful (97%) than did mindfulness participants (77%).

The mindfulness group displayed significantly stronger EEG beta range activity in the insula (d = 1.4) and anterior cingulate cortex (d = 1.0) during the biopsy compared to the control group. There were similar trends for the insula (d = 1.6) and anterior cingulate cortex (d = 0.7) when compared to the focused breathing group.

The mindfulness group also showed a trend towards greater theta activity in three brain regions. Brain wave differences were indicative of improved attention and bodily awareness. There was a trend in both the mindfulness and the focused breathing groups towards reduced delta activity in the precuneus region. This decreased delta activity correlated significantly (r = 0.51) with decreased anxiety during the biopsy.

The study shows that a brief, instructor-led mindfulness meditation is superior to instructor-led focused breathing in reducing anxiety during stereotactic breast biopsy. The study is limited by the fact that a mind-body specialist did not accompany control group participants during the biopsy. Useable EEGs were obtained for only one third of the participants, limiting the statistical power of the analyses.

Reference:

Ratcliff, C. G., Prinsloo, S., Chaoul, A., Zepeda, S. G., Cannon, R., Spelman, A., . . . Cohen, L. (2018). A randomized controlled trial of brief mindfulness meditation for women undergoing stereotactic breast biopsy. Journal of the American College of Radiology.

[Link to abstract]