Open AccessOpinions of women with high inherited breast cancer risk about prophylactic mastectomy: an initial evaluation from a screening trial including magnetic resonance imaging and ductal lavage
Author(s) -
Kurian Allison W.,
Hartman AnneRenee,
Mills Meredith A.,
Ford James M.,
Daniel Bruce L.,
Plevritis Sylvia K.
Publication year - 2005
Publication title -
health expectations
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.314
H-Index - 74
eISSN - 1369-7625
pISSN - 1369-6513
DOI - 10.1111/j.1369-7625.2005.00333.x
Subject(s) - medicine , breast cancer , breast mri , prophylactic mastectomy , mastectomy , mammography , magnetic resonance imaging , breast cancer screening , brca mutation , confidence interval , ductal carcinoma , cancer , gynecology , oncology , radiology
Objective Prophylactic mastectomy (PM) is often considered, but variably chosen by women at high inherited risk of breast cancer; few data exist on patient tolerance of intensive breast screening as an alternative to PM. We performed an evaluation of high‐risk women's tolerance of a breast screening protocol using clinical breast examination, mammography, breast magnetic resonance imaging (MRI) and ductal lavage (DL), and of change in attitudes toward PM after screening. Design A questionnaire assessing tolerance of screening procedures and change in opinion towards PM was designed and administered to 43 study participants, after a median follow‐up of 13 months. Responses were evaluated according to patient characteristics, including type of study‐prompted interventions, BRCA mutation status, and prior history of cancer, via univariate analysis. Results Most patients [85.3% (68.9–95.1%)] were more opposed or unchanged in their attitudes towards PM after study participation, with only 14.7% (5.0–31.1%) less opposed ( P = 0.017) despite a short‐interval follow‐up MRI rate of 71.7% and a biopsy rate of 37%. Lower rates of maximal discomfort were reported with mammogram [2.8% (0–14.5%)] and MRI [5.6% (0–18.7%)] than with DL [28.6% (14.6–46.3%)], with P = 0.035. Conclusions Most high‐risk women tolerated intensive breast screening well; they were not more inclined towards PM after participating. Future studies should prospectively evaluate larger numbers of high‐risk women via multivariate analysis, to determine characteristics associated with preference for breast screening vs. PM.