Distress and breast cancer anxiety (BCA) among BRCA mutation carriers participating in MRI-based screening

Abstract

20001 Background: MRI has consistently been shown to be a more sensitive screening tool than mammography (M) but its lower specificity could have negative psychological effects. In a pilot study (SABCS 2004) no adverse psychological effects of MRI screening were found. A larger study was then done to look particularly at the impact of imaging recalls and biopsies. Methods: BRCA mutation carriers having breast screening with annual M, MRI, and ultrasound (US) + 6monthly clinical breast examination (CBE) were asked to complete questionnaires: 1 - 2 wks pre, 4 - 6 weeks after, and 6 months after their imaging. Questionnaires included the hospital anxiety and depression scale (HADS), a modified Kash breast cancer anxiety scale (BCAS), the monitor/blunter scale, a rating of overall health on a linear analog scale, a 4 category rating of anxiety related to each screening modality, and a description of any recent life altering events. Results: 54 women (29 BRCA1, 25 BRCA2) completed at least 2 questionnaires (median 3, range 2–5). Mean age was 44 (range 28–64). 26% were surveyed during their 1st round of screening. There was a very strong correlation between the BCAS and HADS anxiety with 19 (35%) having baseline BCA of whom 15 (79%) were monitors compared to 60% monitors among the patients without BCA. At baseline 41 (76%) indicated moderate/high MRI related anxiety compared to 61%, 46%, and 43% for M, U/S and CBE. Of the 16 patients (30%) who had recalls ± biopsy (n = 5) while on this study, 10 (63%) had elevated BCA and 3(19%) increased depression at baseline. In all but 2 women whose anxiety increased due to life events, no scores changed significantly after recall or biopsy. Only 1 cancer was diagnosed during the study period. In the other 38 women scores changed significantly only as a result of life events. Conclusions: Despite a high false positive rate, MRI-based screening had no detectable adverse psychological effects on BRCA mutation carriers in this study. No significant financial relationships to disclose.