The genetic and epigenetic influences on pain after breast cancer surgery

Abstract

Persistent pain after breast cancer surgery (PPBCS) is both common and debilitating, lasting months to years after surgery, a mainstay treatment of breast cancer. The current body of PPBCS evidence has focussed on identifying clinical, psychological and treatment related risk factors however, emerging evidence suggests that genomic and neurophysiologic factors (as measured by preoperative quantitative sensory testing - QST) may also contribute. Despite the high prevalence of breast cancer and breast cancer surgery, there has been a paucity of PPBCS investigation in New Zealand. The aim of this thesis was to assess the prevalence and impact of PPBCS in a New Zealand population and identify risk factors (clinical, demographic, psychological, neurobiological and inherited (genetic)) for PPBCS development. Additionally, this thesis aimed to investigate possible longitudinal epigenetic changes that may occur in the postoperative period. In this thesis, PPBCS was defined as pain in the ipsilateral breast, axilla, arm, shoulder or chest wall daily ≥6 months after surgery.