Patient Perceptions of Breast Cancer Risk in Imaging-Detected Low-Risk Scenarios and Thresholds for Desired Intervention: A Multi-Institution Survey |
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| Institution: | 1. Department of Radiology, Duke University Medical Center, Durham, North Carolina;2. Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina;3. Department of Radiology, University of Texas Southwestern, Dallas, Texas;4. Riverside Radiology and Interventional Associates, Inc., Columbus, Ohio;5. Department of Radiology, Albany Medical Center, Albany, New York;1. Center for Health Policy and Healthcare Research, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts;2. Department of Radiology-MRI, Brigham and Women’s Hospital, Boston, Massachusetts;3. Harvard Medical School, Cambridge, Massachusetts;4. Department of Radiology, Division of Abdominal Imaging, Beth Israel Deaconess Medical Center (BIDMC), Boston, Massachusetts;5. Center for Health Policy and Healthcare Research, D’Amore-McKim School of Business and Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts;1. Department of Radiology, Duke University Medical Center, Durham, North Carolina;2. Greensboro Radiology, Greensboro, North Carolina;3. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina;4. University of North Carolina School of Medicine, Chapel Hill, North Carolina;5. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina;6. Department of Surgery, Duke University Medical Center, Durham, North Carolina;1. Department of Radiology, St. George''s Healthcare NHS Trust, London SW17 0QT, UK;2. Department of Pathology, NYU School of Medicine, 550 First Avenue, New York, NY 10016, USA;3. Department of Radiology, NYU Cancer Institute, Breast Imaging Center, NYU School of Medicine, 160 East 34th Street, 3rd Floor, New York, NY 10016, USA |
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| Abstract: | PurposeTo determine women’s perceptions of breast cancer risk and thresholds for desiring biopsy when considering BI-RADS 3 and 4A scenarios and recommendations, respectively.Materials and MethodsWomen presenting for screening mammography from five geographically diverse medical centers were surveyed. Demographic information and baseline anxiety were queried. Participants were presented with scenarios of short-term imaging follow-up recommendations (ie, BI-RADS 3) and biopsy recommendations (ie, BI-RADS 4A) for low-risk mammographic abnormalities and asked to estimate their breast cancer risk for each scenario. Participants reported the threshold (ie, likelihood of cancer) where they would feel comfortable undergoing short-term imaging follow-up and biopsy and their anticipated regret for choosing short-term follow-up versus biopsy.ResultsAnalysis of 2,747 surveys showed that participants estimated breast cancer risk of 32.8% for a BI-RADS 3 and 41.1% for a BI-RADS 4A scenarios are significantly greater rates than clinically established rates (<2% P < .001] and 2%-10% P < .001], respectively). Over one-half (55.4%) of participants reported they would never want imaging follow-up if there was any chance of cancer; two-thirds (66.2%) reported they would desire biopsy if there was any chance of cancer. Participants reported greater anticipated regret (P < .001) and less relief and confidence (P < .001) with the decision to undergo follow-up imaging versus biopsy.ConclusionWomen overestimate breast cancer risk associated with both BI-RADS 3 and 4A scenarios and desire very low biopsy thresholds. Greater anticipated regret and less relief and confidence was reported with the choice to undergo short-term imaging follow-up compared with biopsy. |
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| Keywords: | Breast cancer patient perception risk BI-RADS shared decision making |
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