Psychoneuroimmunological manifestations of stress in women undergoing breast biopsy

This research examined key biological and psychological processes in twenty-nine women undergoing stereotactic or ultrasound guided needle breast biopsy. Aim 1 was to identify perceptions of stress, neuroendocrine and immune manifestations of stress, and to explore potential modifiers of stress (social support and coping processes) pre- and post- biopsy. Aim 2 was to further explore and expand PNI theory by examining the relationships among perceived stress, coping, social support, and neuroendocrine and immune markers. The study used a descriptive design with repeat measures at two time points: Time I was 5-8 days before scheduled biopsy and Time 2 was 5-8 days after receiving biopsy results. The instruments used to assess anxiety, perceived stress, social support and coping were the State-Trait Anxiety Inventory, Social Provisions Scale, Impact of Event Scale, Impact of Event-revised, and the WAYS of coping Questionnaire. Physiological measures included Natural Killer and LAK cytotoxicity, salivary cortisol (4 samples over two days), and Type 1 (IL-1beta, IL-2, IL-12, IFN-gamma, TNF-alpha) and Type 2 (IL-4, IL-6, IL-10) cytokine production.; All physiological measures were obtained within the same early morning time-period to minimize effects of circadian variation. The paired t-test and correlational statistics were used to analyze results and yielded a number of significant findings at the alpha = 0.05 level. Women perceived greater levels of stress pre-biopsy than post-biopsy. The level of perceived stress was directly related to social support. Women in this study were more likely to use emotion-focused coping processes during the pre-biopsy period and problem-oriented coping strategies were used more often after receiving biopsy results. There were no changes in salivary cortisol levels between Time 1 and Time 2, although salivary cortisol levels in this sample were about three times higher than reported norms. There were changes in NK and LAK cells at Time 1 that indicated immune mobilization processes were in effect. In addition, there were interesting changes in cytokines---particularly IFN-gamma and TNF-beta as well as IFN-gamma /IL-10 ratio changes. Finally, there were some significant age-related changes in NK cells and findings which may suggest racial variation in cytokine production of IL-10 and IL-12.