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
Article first published online: 2 AUG 2005
Volume 8, Issue 3, pages 221–233, September 2005
How to Cite
Kurian, A. W., Hartman, A.-R., Mills, M. A., Ford, J. M., Daniel, B. L. and Plevritis, S. K. (2005), 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. Health Expectations, 8: 221–233. doi: 10.1111/j.1369-7625.2005.00333.x
- Issue published online: 2 AUG 2005
- Article first published online: 2 AUG 2005
- Accepted for publication 11 March 2005
- breast cancer;
- ductal lavage;
- magnetic resonance imaging;
- patient satisfaction;
- prophylactic mastectomy
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.