Psychological consequences of MRI-based screening among women with strong family histories of breast cancer

• Published in: Breast cancer research and treatment Vol. 189; no. 2; pp. 497 - 508
• Main Authors: Castelo, Matthew, Brown, Zachary, D’Abbondanza, Josephine A., Wasilewski, Nastasia V., Eisen, Andrea, Muradali, Derek, Hansen, Bettina E., Grunfeld, Eva, Scheer, Adena S.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2021; Springer; Springer Nature B.V
• Subjects: Anxiety; Biopsy; Breast cancer; Cancer; Cancer research; Diagnosis; Epidemiology; Gene mutations; Genetic aspects; Magnetic resonance imaging; Medicine; Medicine & Public Health; Mutation; Oncology; Oncology, Experimental; Surveys; Women; MRI; Young women; High-risk
• ISSN: 0167-6806; 1573-7217
• DOI: 10.1007/s10549-021-06300-w

Purpose
MRI-based screening in women with a ≥ 25% lifetime risk of breast cancer , but no identifiable genetic mutations may be associated with false positives. This study examined the psychological impact of abnormal screens and biopsies in non-mutation carriers participating in high-risk screening with no personal history of breast cancer.
Methods
Non-mutation carriers participating in the High-Risk Ontario Breast Screening Program at two sites were mailed demographic surveys, psychological scales, and chart review consent. Scales included the Consequences of Screening in Breast Cancer questionnaire, Lerman Breast Cancer Worry Scale, and Worry Interference Scale. Missing data were managed with multiple imputation. Multivariable regression was used to assess whether abnormal screens or biopsies were associated with adverse psychological effects.
Results
After contacting 465 participants, 169 non-mutation carriers were included. Median age was 46 years (range 30–65). Over a median 3 years of screening, 63.9% of women experienced at least one abnormal screen, and 24.9% underwent biopsies. Statements relating to cancer worry/anxiety scored highest, with 19.5% indicating they worried “a lot”. Higher scores among anxiety-related statements were strongly associated with higher dejection scores. Overall, coping and daily functioning were preserved. Women indicated some positive reactions to screening, including improved existential values and reassurance they do not have breast cancer. Abnormal screens and biopsies were not significantly associated with any psychological scale, even after adjustment for patient characteristics.
Conclusion
Non-mutation carriers undergoing MRI-based screening had considerable baseline anxiety and cancer worry, although daily functioning was not impaired. Abnormal screens and biopsies did not appear to have adverse psychological effects.