Patient Perceptions of Breast Cancer Risk in Imaging-Detected Low-Risk Scenarios and Thresholds for Desired Intervention: A Multi-Institution Survey

Lars J. Grimm, Rebecca A. Shelby, Emily E. Knippa, Eun L. Langman, Lauren S. Miller, Beth E. Whiteside, Mary Scott C. Soo

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To 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 Methods: Women 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. Results: Analysis 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. Conclusion: Women 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.

Original languageEnglish (US)
Pages (from-to)911-919
Number of pages9
JournalJournal of the American College of Radiology
Volume15
Issue number6
DOIs
StatePublished - Jun 2018

Keywords

  • BI-RADS
  • Breast cancer
  • patient perception
  • risk
  • shared decision making

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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