Researchers in Aberdeen will shortly lead a major study of women with breast cancer in a bid to establish the factors that might influence the chronic pain many women suffer after surgery.
The Cancer Research UK funded study involves researchers and clinicians from the Universities of Aberdeen and Dundee and Aberdeen Royal Infirmary, Ninewells Hospital in Dundee, and Raigmore Hospital in Inverness.
Women in Grampian, Tayside and Highland will be involved in the three-year study which will assess patients before and after surgery to identify possible clinical and psychological reasons behind chronic pain.
Up to a third of women experience this type of pain after breast cancer surgery. Depending on the severity, it can seriously affect the quality of their life.
Almost 30 years ago, it was observed that some women had aching or burning sensations in their arm or armpit after a mastectomy. Women who have had breast conservation surgery – procedures like lumpectomies - can also suffer the pain which can be a mild irritation or a severe disabling ache.
Originally the occurrence, after breast cancer surgery, of chronic pain – chronic pain is classified as a pain that lasts at least three months – was thought to be uncommon. Now it is known to be a common condition worldwide with estimates of up to half of women still affected one year after surgery.
Now the charity Cancer Research UK has given University of Aberdeen researchers £189,000 to study the factors that might influence that pain which is known as Post Mastectomy Pain Syndrome or PMPS.
Principal investigator Dr Julie Bruce, MRC Senior Research Fellow, within the University’s Department of Public Health, said: “Chronic pain after surgery is more common than was previously thought and as survival from breast cancer has improved there is increased emphasis on improving quality of life.
“With mortality falling, many women are now living longer with the side effects of cancer and its treatment. Therefore there is a need to better understand these conditions and the potential factors that may lead to the development of chronic pain, so that we can develop interventions for prevention and treatment. “
Professor Steven Heys, Professor of Surgical Oncology at the University of Aberdeen and Consultant Surgeon, is one of the investigators. He said: “It really is an important issue that we have not paid enough attention to before. Understandably, breast cancer surgeons are concerned with getting the patient cancer free and the other things that can happen after surgery have been seen to be of lesser importance.
“Women who have been treated for breast cancer are usually checked every six months for the next five years after having surgery and it has become evident that many do have pain and other symptoms which are interfering with their daily activities.”
In 1999 the University conducted a study of 408 women from Grampian who had undergone breast cancer surgery and found that 43% had suffered from post-mastectomy pain at some point. Of those, 29% still reported symptoms at the time of survey which took place three years after surgery. The women reported “stabbing”, “shooting” and “burning” sensations in the chest, arm and/or armpit region, which were aggravated by shoulder movement. Younger women were at higher risk of developing post-mastectomy pain.
The women were reassessed in 2003 and of those who had experienced PMPS, half continued to suffer from persistent or intermittent pain up to seven years after surgery.
The exact cause of PMPS is unknown, although various theories have been suggested, including damage to the major nerves during tumour removal. However, more recent studies have found that chronic pain and abnormal sensations can still occur after breast conservation surgery, where smaller incisions have been made and where major nerves have been preserved. This suggests that other factors may also contribute to the development of chronic pain.
Dr Bruce added: “There is some evidence that psychological factors, including pre-operative anxiety, negative mood and beliefs about expected pain are associated with levels of pain in the first few weeks after surgery.
“We want to explore this further by assessing anxiety and pain levels in the acute period and also up to nine months after surgery. Although anxiety does not cause chronic pain, it is likely to affect perception of pain and may also impact upon the level of distress and disability associated with pain. We are working in collaboration with health psychologists to explore these factors.”
The study is expected to begin in November and women newly diagnosed with primary breast cancer will be asked to take part. Clinical and psychological assessment will be conducted pre-operatively, and at four and nine months after surgery, to identify risk factors for the onset of chronic pain and to determine quality of life and general well-being after breast cancer surgery.