Opinions 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

• Published in: Health expectations : an international journal of public participation in health care and health policy 2005-09, Vol.8 (3), p.221-233
• Main Authors: Kurian, Allison W., Hartman, Anne-Renee, Mills, Meredith A., Ford, James M., Daniel, Bruce L., Plevritis, Sylvia K.
• Format: Article
• Language: English
• Subjects: Adult; Alternatives; Attitudes; Bilateral prophylactic mastectomy; Biopsy; BRCA; Breast - cytology; Breast - surgery; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - genetics; Breast Neoplasms - prevention & control; Breast Neoplasms - psychology; Breast Self-Examination; Discomfort; ductal lavage; Evaluation; Female; Genes, BRCA1; Genes, BRCA2; Genetic family histories; Genetic Predisposition to Disease - psychology; Health risks; High risk; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - utilization; Mammography; Mammography - psychology; Mammography - utilization; Mastectomy; Mastectomy - psychology; Mastectomy - utilization; Medical imaging; Medical screening; Middle Aged; Multivariate analysis; Mutation; Ovarian cancer; Patient Acceptance of Health Care; Patient satisfaction; Patients' Preferences; Prophylactic mastectomy; Risk Assessment; Screening; Surveys and Questionnaires; Therapeutic Irrigation; Tolerance; USA; Women; Women's Health
• ISSN: 1369-6513; 1369-7625
• DOI: 10.1111/j.1369-7625.2005.00333.x

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.