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Cited by 44Cancer survivorship and careWomen's cancer prevention and managementCancer-related cognitive impairment studies

Persistent breast pain in post-surgery breast cancer survivors and women with no history of breast surgery or cancer: associations with pain catastrophizing, perceived breast cancer risk, breast cancer worry, and emotional distress

Open access
Bovbjerg, Dana H., Keefe, Francis J., Soo, Mary S., Manculich, Jessica, Van Denburg, Alyssa, Zuley, Margarita L., Ahrendt, Gretchen M., Skinner, Celette S. +2 more·2019·Acta Oncologica
DOI 10.1080/0284186x.2019.1574023PMC PMC6612426
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Abstract

Background: Persistent breast pain (PBP) is prevalent among breast cancer survivors and has powerful negative psychological consequences. The present study provided a first test of the hypothesis that: (a) pain catastrophizing, (b) heightened perceived risk of cancer, and (c) worry that pain indicates cancer may be independent mediating links between breast cancer survivors’ experiences of PBP and heightened emotional distress.Methodology: We assessed levels of PBP and psychological factors in breast cancer survivors (Survivor Group: n = 417; Stages I-IIIA; White = 88.7%; Age M = 59.4 years) at their first surveillance mammogram post-surgery (6–15 months). A comparison group of women without histories of breast surgery or cancer (Non-cancer Group: n = 587; White = 78.7%; Age M = 57.4 years) was similarly assessed at the time of a routine screening mammogram. All women completed measures of breast pain, pain catastrophizing, perceived breast cancer risk, and worry that breast pain indicates cancer, as well as measures of emotional distress (symptoms of anxiety, symptoms of depression, and mammography-specific distress). Analyses included race, age, BMI, education, and menopausal status as covariates, with significance set at 0.05.Results: As expected, PBP prevalence was significantly higher in the Survivor Group than in the Non-cancer Group (50.6% vs. 17.5%). PBP+ survivors also had significantly higher levels of emotional distress, pain catastrophizing, mammography-specific distress, and worry that breast pain indicates cancer, compared to PBP− survivors. Structural equation modeling results were significant for all hypothesized mediational pathways. Interestingly, comparisons of PBP+ to PBP− women in the Non-cancer Group showed similar results.Conclusion: These findings suggest the importance of (a) pain catastrophizing, (b) perceived breast cancer risk and, (c) worry that breast pain may indicate cancer, as potential targets for interventions aimed at reducing the negative psychological impact of PBP in post-surgery breast cancer survivors, as well as in unaffected women with PBP due to unknown reasons.

Integrity signals

Registry

Crossref · 10.1080/0284186x.2019.1574023

Cites

44 of 44 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 20 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Survivors were significantly more likely than non-cancer women to have clinically significant breast pain (intensity ≥3) (21.8% vs 4.8%).

    “Survivors were also significantly more likely to have clinically significant breast pain (i.e., pain intensity ≥3) than women in the Non-cancer Group (21.8% vs. 4.8%, respectively; OR=5.6, p<.001, 95% CI=3.5 to 8.9).”
    Quote in the paperSubstantial claim
  • Findingown data

    In the Non-cancer Group, women with persistent breast pain had significantly higher pain catastrophizing than those without.

    “We found that even in this Non-cancer Group, women with PBP had significantly higher levels of general anxiety symptoms, pain catastrophizing, and worry that breast pain indicates cancer compared to women without PBP.”
    Quote in the paperSubstantial claim
  • Findingown data

    In the Survivor Group model, persistent breast pain was not associated with perceived risk (β=.08, p=.11).

    “PBP was not associated with perceived risk (β=.08, p=.11).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Higher pain catastrophizing was directly related to greater worry (β=.22).

    “Higher pain catastrophizing was directly related to greater worry (β=.22, p<.001), higher perceived risk (β=.11, p=.04), and greater emotional distress (β=.35, p<.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    The total effect of persistent breast pain on emotional distress was significantly positive (β=.23).

    “the total effect (including direct and indirect effects) indicated a significant positive relationship between PBP and emotional distress (β=.23, p<.001).”
    Quote in the paperSubstantial claim
  • May combine two claims. 5
  • Classified as probably not a substantial claim. 10

  • May combine two claims.

    Findingown data

    For anxiety, pain catastrophizing, and worry, levels did not significantly differ between women with and without a history of breast surgery or cancer.

    “For these variables, the levels seen in women with and without a history of breast surgery and cancer were not significantly different”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The model explained 58% of the variance in emotional distress, 25% in worry, 13% in perceived risk, and 9% in pain catastrophizing.

    “The model accounted for 58% of the variance in emotional distress, 25% of the variance in worry, 13% of the variance in perceived risk, and 9% of the variance in pain catastrophizing.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A meta-analysis of prospective studies found no significant downstream effect of trait or state psychological factors on subsequent persistent breast pain.

    “a recent meta-analysis of prospective studies examining psychological factors as predictors of subsequent PBP did not find trait or state psychological factors to have a significant downstream impact on PBP [20].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A Danish nationwide cross-sectional study of 3253 women found that 47% reported surgical-area pain two to three years after breast cancer surgery, and 13% reported severe pain.

    “In a widely cited nationwide cross-sectional study (n=3253) from Denmark, 47% of women reported having pain in the surgical area two to three years after undergoing a mastectomy or breast conserving surgery for primary breast cancer, and 13% reported severe pain [13].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A meta-analysis of 23 studies reported a median prevalence of 37.5% for persistent breast pain after breast cancer surgery.

    “A recent meta-analysis of PBP following breast cancer surgery reported a median prevalence of 37.5% across 23 studies”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Number of body pain locations (excluding breast) was included as a covariate.

    “Number of body pain locations (excluding breast) was also included as a covariate in the model to control for the potential relationships between other pain conditions and study variables.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    The study's strengths include a relatively large, multi-site sample of breast cancer survivors, all of whom had breast-conserving surgery and were assessed at the clinically uniform time of their first mammogram surveillance.

    “Strengths include the relatively large, multi-site, sample of breast cancer survivors, all of whom had undergone breast-conserving surgery and were assessed at the clinically uniform time of their first mammogram surveillance for breast cancer following surgery.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductnone given

    The inclusion of a comparison group of women without a history of breast surgery or cancer is a major strength.

    “While the inclusion of a comparison group of women without a history of breast surgery or cancer is a major strength of the study”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The need to control for some demographic differences between the groups was a limitation.

    “the need to control for some demographic differences between the groups was a limitation of the study”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The present results highlight pain catastrophizing, perceived risk of breast cancer, and worry that pain may indicate cancer as important potential targets for intervention.

    “the present results highlight pain catastrophizing, perceived risk of breast cancer, and worry that pain may indicate cancer as important potential targets for intervention.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Psychological factors such as pain catastrophizing are potentially modifiable.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study used race, age, BMI, education, and menopausal status as covariates.

    “Variables that differed (p<.05) by group were included as covariates in subsequent analyses; these included race, age, BMI, education, and menopausal status.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The cross-sectional nature of the data collection can only establish associations among variables consistent with potential causal connections.

    “The principal limitation is the cross-sectional nature of the data collection, which can only establish associations among variables consistent with potential causal connections.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Institutional Review Boards at both sites reviewed and approved the protocol and all participants provided written informed consent.

    “Institutional Review Boards at both sites reviewed and approved the protocol and all participants provided written informed consent.”
    Quote in the paperNot a substantial claim
13 of 13

  • The paper relies on this without support.

    Persistent breast pain in women without a history of breast surgery or cancer is due to unknown causes.

    “who have PBP due to unknown causes”
    “who have PBP due to unknown reasons”

  • The paper relies on this without support.

    Psychological factors such as pain catastrophizing are potentially modifiable.

    “potentially modifiable psychological factors (e.g., pain catastrophizing)”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(3, 945) = 13.5reported p < .001 · recomputed p < .001

    “F(3,945)=13.5, p < .001”

  • ConsistentF(3, 945) = 8.3reported p < .001 · recomputed p < .001

    “F(3,945)=8.3, p < .001”

  • ConsistentF(3, 911) = 130.4reported p < .001 · recomputed p < .001

    “F(3,911)=130.4, p < .001”

  • ConsistentF(3, 935) = 16.1reported p < .001 · recomputed p < .001

    “F(3,935)=16.1, p < .001”

  • ConsistentF(3, 939) = 10.5reported p < .001 · recomputed p < .001

    “F(3,939)=10.5, p < .001”

  • Consistentχ²(3) = 307.8reported p < .001 · recomputed p < .001

    “χ2(3)=307.8, p < .001”

  • Consistentz = 2.7reported p = .008 · recomputed p = .007

    “Z=2.7, p = .008”

  • Consistentz = 5.2reported p < .001 · recomputed p < .001

    “Z=5.2, p < .001”

  • Consistentz = 4reported p < .001 · recomputed p < .001

    “Z=4.0, p < .001”

  • Consistentz = 1.9reported p = .06 · recomputed p = .057

    “Z=1.9, p = .06”

10 of 10

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract overstates the mediation results

    Major

    The abstract says every hypothesized mediation pathway was significant, but the results report a nonsignificant pathway through perceived risk and only a trend for another pathway through perceived risk.

  • Non-cancer group sample size differs across sections

    Minor

    The paper reports the Non-cancer Group as n=587 in the abstract and participants section, but the discussion later states n=586. This is an internal inconsistency in the reported sample size.

  • Non-cancer group size differs in the discussion

    Minor

    The discussion gives 586 women in the Non-cancer Group, whereas the participant description gives 587.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Cleeland CS, 1994, Ann Acad Med Singap, 23, 129

Cited by

Sorted by citations

Related

Authors
Bovbjerg, D. H., Keefe, F. J., Soo, M. S., Manculich, J., Van Denburg, A., Zuley, M. L., Ahrendt, G. M., Skinner, C. S., Edmond, S. N., & Shelby, R. A.
Affiliations
  • University of Pittsburgh (US)
  • Duke University (US)
  • Duke University Medical Center, Duke University, Durham, NC, USA;
  • University of Colorado Hospital (US)
  • Harold C. Simmons Comprehensive Cancer Center (US)
Corresponding author
Bovbjerg, Dana H.
ORCID
Venue
Acta Oncologica
Publisher
MJS Publishing, Medical Journals Sweden AB
Published
2019-02-12
Volume
58
Issue
5
Pages
763-768
ISSN
  • 0284-186X (ISSN-L)
  • 1651-226X
DOI
10.1080/0284186x.2019.1574023
PMC
PMC6612426
OpenAlex
W2914320815
Cited by
44
References
44
Citations by year
2026: 4 · 2025: 5 · 2024: 6 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 2 · 2019: 5
FWCI
2.30
Type
journal article
Language
en
Open access
Locations
  • Acta Oncologica (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Figshare (submittedVersion, cc-by)
  • Figshare (cc-by)
Funders
NIH/NCI (R01 CA131148, P30 CA047904)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
Keywords
breast cancer survivors, pain catastrophizing, breast cancer worry, emotional distress, anxiety, depression, mediation, psychological impact of cancer
MeSH terms
Cancer Survivors, Adaptation, Psychological, Breast Neoplasms, Cross-Sectional Studies, Depression, Female, Humans, Mammography, Middle Aged, Neoplasm Recurrence, Local, Stress, Psychological, Catastrophization, Mastodynia

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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