Matthew Castelo1,2,3,4, Zachary Brown5, Josephine A D'Abbondanza6, Nastasia V Wasilewski7,8, Andrea Eisen9, Derek Muradali10, Bettina E Hansen2, Eva Grunfeld11, Adena S Scheer12,13,14,15,16. 1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. 2. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. 3. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 4. Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada. 5. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 6. Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. 7. Division of General Surgery, Department of Surgery, Health Sciences North, Sudbury, ON, Canada. 8. Northern Ontario School of Medicine, Sudbury, ON, Canada. 9. Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 10. Department of Medical Imaging, St. Michael's Hospital, Toronto, ON, Canada. 11. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. 12. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. adena.scheer@unityhealth.to. 13. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. adena.scheer@unityhealth.to. 14. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. adena.scheer@unityhealth.to. 15. Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada. adena.scheer@unityhealth.to. 16. Division of General Surgery, St. Michael's Hospital, 3-005 Donnelly Wing, 30 Bond St, Toronto, ON, M5B 1W8, Canada. adena.scheer@unityhealth.to.
Abstract
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.
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.
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