Age-related differences in psychological distress and persistent postsurgical pain after surgery for management of non-invasive breast lesions

Younger women who have undergone surgery for non-invasive breast lesions may experience heightened psychological distress and persistent postsurgical pain (PPSP). We investigated whether younger age was associated with worse PPSP outcomes, and whether depression or anxiety contributed to these associations.

This was a secondary analysis of a cross-sectional survey of women (N = 821; Mean age = 60, range:26–88) who underwent surgical management of ductal carcinoma in situ (DCIS) or high-risk lesions (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ). Participants completed assessments of surgical-site pain severity, frequency, and impact of pain on cognitive/emotional and physical functioning, as well as measures of depression and anxiety. Mediation analyses tested whether depression or anxiety contributed to associations between younger age and worse PPSP outcomes, controlling for relevant surgical and treatment factors.

Overall, 15% of women reported clinically significant PPSP (≥ 3/10). Younger age was associated with higher rates of clinically significant PPSP, higher pain severity index (PSI) scores, greater impact of pain on cognitive/emotional functioning, and higher depression and anxiety (all p-values < 0.001). Mediation analyses indicated that depression, but not anxiety, partially contributed to the association between younger age and worse PPSP outcomes.

Depression contributed to the association of younger age with worse PPSP outcomes among women undergoing surgery for non-invasive breast lesions. These results underscore the importance of screening for PPSP and depression following surgery, particularly in younger women. Targeted psychological interventions may help improve long-term recovery in this vulnerable group.