Intermediate Risk Of Breast Cancer Research Articles

Added Value of Supplemental Screening Breast MRI in Women at Average or Intermediate Breast Cancer Risk Using Abbreviated Protocols

Background: The importance of magnetic resonance imaging (MRI) screening in high-risk women is well-known; however, its utility in women at average or intermediate risk is not well-established. The main purpose of the study was to investigate the added value and cancer detection rate (CDR) of using abbreviated MRI protocols in average or intermediate-risk women. Methods: A total of 431 asymptomatic women with average or intermediate risk of breast cancer who underwent screening abbreviated MRI from May 2019 to May 2022 were recruited. CDR in screening MRI among average or intermediate-risk women and in low or high-breast composition was calculated. Results: In 173 patients with intermediate risk, 5(1.16%) malignant lesions were detected and in 258 average-risk patients, 10(2.32%) added cancers were found in screening abbreviated MRI compared to mammography. Among the 15 malignant lesions, more cancers in high breast composition were detected (11 vs. 4 cases); however, there was no statistically significant difference between the cancer detection rate and breast composition. In intermediate-risk women with high breast composition, 3 (0.69%) malignant lesions, and in average-risk women with high breast composition, 8 (1.85%) added cancers were found. Conclusion: We provided 3.48% added cancer detection in screening abbreviated MRI compared to mammography. Therefore, screening abbreviated MRI with less image acquisition and interpretation time may be useful as a supplemental screening tool for cancer detection especially in high breast composition.

Economic evaluation of supplemental breast cancer screening modalities to mammography or digital breast tomosynthesis in women with heterogeneously and extremely dense breasts and average or intermediate breast cancer risk in US healthcare

ObjectiveTo evaluate the cost-effectiveness of supplemental breast imaging modalities for women with heterogeneously and extremely dense breasts and average or intermediate risk of breast cancer (BC) in the USA, and analyze capacity requirements for supplemental magnetic resonance imaging (MRI) and contrast-enhanced mammography (CEM).MethodsClinical and economic outcomes for supplemental imaging modalities including full- and abbreviated-protocol MRI (Fp-MRI, Ab-MRI), CEM, and ultrasound (U/S) as add-on to x-ray mammography (XM) or digital breast tomosynthesis (DBT), were compared to XM or DBT alone, in a decision tree linked to a Markov chain validated by comparison with a microsimulation analysis. A Delphi panel supplemented model input parameters from the literature. A capacity model evaluated the number of additional daily scans and scanners required for Fp-MRI and CEM.ResultsCompared to XM or DBT alone, all supplemental imaging protocols were cost-effective. Both Fp- and Ab-MRI, and to a lesser extent CEM and U/S, yielded superior clinical outcomes to XM or DBT. Compared to XM alone, U/S and Ab-MRI had the lowest incremental cost-effectiveness ratios (ICER). For U/S, the ICER was $23,394 for the average-risk population and $13,241 for the intermediate-risk population. For CEM, the ICER was $38,423 and $23,772, respectively. For the extremely dense subpopulation with intermediate risk, supplemental screening requirements could be accommodated by conducting one Fp-MRI scan per day per existing general scanner.ConclusionsWhile ultrasound had the lowest ICER, MRI and CEM demonstrated the best clinical outcomes, compared to XM or DBT alone for women with dense breasts and intermediate and high risk. Existing MRI scanner capacity has the potential to meet most of the supplemental screening needs of this population.

Supplemental Breast Cancer Screening in Women with Dense Breasts and Negative Mammography: A Systematic Review and Meta-Analysis.

Background The best supplemental breast cancer screening modality in women at average risk or intermediate risk for breast cancer with dense breast and negative mammogram remains to be determined. Purpose To conduct systematic review and meta-analysis comparing clinical outcomes of the most common available supplemental screening modalities in women at average risk or intermediate risk for breast cancer in patients with dense breasts and mammography with negative findings. Materials and Methods A comprehensive search was conducted until March 12, 2020, in Medline, Epub Ahead of Print and In-Process and Other Non-Indexed Citations; Embase Classic and Embase; Cochrane Central Register of Controlled Trials; and Cochrane Database of Systematic Reviews, for Randomized Controlled Trials and Prospective Observational Studies. Incremental cancer detection rate (CDR); positive predictive value of recall (PPV1); positive predictive value of biopsies performed (PPV3); and interval CDRs of supplemental imaging modalities, digital breast tomosynthesis, handheld US, automated breast US, and MRI in non-high-risk patients with dense breasts and mammography negative for cancer were reviewed. Data metrics and risk of bias were assessed. Random-effects meta-analysis and two-sided metaregression analyses comparing each imaging modality metrics were performed (PROSPERO; CRD42018080402). Results Twenty-two studies reporting 261 233 screened patients were included. Of 132 166 screened patients with dense breast and mammography negative for cancer who met inclusion criteria, a total of 541 cancers missed at mammography were detected with these supplemental modalities. Metaregression models showed that MRI was superior to other supplemental modalities in CDR (incremental CDR, 1.52 per 1000 screenings; 95% CI: 0.74, 2.33; P < .001), including invasive CDR (invasive CDR, 1.31 per 1000 screenings; 95% CI: 0.57, 2.06; P < .001), and in situ disease (rate of ductal carcinoma in situ, 1.91 per 1000 screenings; 95% CI: 0.10, 3.72; P < .04). No differences in PPV1 and PPV3 were identified. The limited number of studies prevented assessment of interval cancer metrics. Excluding MRI, no statistically significant difference in any metrics were identified among the remaining imaging modalities. Conclusion The pooled data showed that MRI was the best supplemental imaging modality in women at average risk or intermediate risk for breast cancer with dense breasts and mammography negative for cancer. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Hooley and Butler in this issue.

Screening MRI in Women at Intermediate Breast Cancer Risk: An Update of the Recent Literature.

Guidelines issued by the American Cancer Society (ACS) in 2007 recommend neither for nor against screening MRI in women at intermediate breast cancer risk (15%-20%), including those with dense breast tissue, a history of lobular neoplasia or atypical ductal hyperplasia (ADH), or a prior breast cancer, because of scarce supporting evidence about the utility of MRI in these specific patient populations. However, since the issuance of the ACS guidelines in 2007, multiple investigations have found that women at intermediate risk may be suitable candidates for screening MRI, given the high detection rates of early-stage cancers and acceptable false-positive rates. For women with dense breast tissue, the Dense Tissue and Early Breast Neoplasm Screening trial reported that the incremental cancer detection rate (CDR) by MRI exceeded 16 cancers per 1000 examinations but decreased in the second round of screening; this decrease in CDR, however, occurred alongside a marked decrease in the false-positive rate. For women with lobular neoplasia or ADH, single-institution retrospective analyses have shown CDRs mostly ranging from 11 to 16 cancers per 1000 MRI examinations, with women with lobular carcinoma in situ benefitting more than women with atypical lobular hyperplasia or ADH. For patients with a prior breast cancer, the cancer yield by MRI varies widely but mostly ranges from 8 to 20 cancers per 1000 examinations, with certain subpopulations more likely to benefit, such as those with dense breasts. This article reviews and summarizes more recent studies on MRI screening of intermediate-risk women.

Cost-Effectiveness of MR-Mammography in Breast Cancer Screening of Women With Extremely Dense Breasts After Two Rounds of Screening.

ObjectivesTo evaluate the cost-effectiveness of MR-mammography (MRM) vs. x-ray based mammography (XM) in two-yearly screening women of intermediate risk for breast cancer in the light of recent literature.MethodsDecision analysis and Markov modelling were used to compare cumulative costs (in US-$) and outcomes (in QALYs) of MRM vs. XM over the model runtime of 20 years. The perspective of the U.S. healthcare system was selected. Incremental cost-effectiveness ratios (ICER) were calculated and related to a willingness to pay-threshold of $ 100,000 per QALY in order to evaluate the cost-effectiveness. Deterministic and probabilistic sensitivity analyses were conducted to test the impact of variations of the input parameters. In particular, variations of the rate of false positive findings beyond the first screening round and their impact on cost-effectiveness were assessed.ResultsBreast cancer screening with MRM resulted in increased costs and superior effectiveness. Cumulative average costs of $ 6,081 per woman and cumulative effects of 15.12 QALYs were determined for MRM, whereas screening with XM resulted in costs of $ 5,810 and 15.10 QALYs, resulting in an ICER of $ 13,493 per QALY gained. When the specificity of MRM in the second and subsequent screening rounds was varied from 92% to 99%, the ICER resulted in a range from $ 38,849 to $ 5,062 per QALY.ConclusionsBased on most recent data on the diagnostic performance beyond the first screening round, MRM may remain the economically preferable alternative in screening women of intermediate risk for breast cancer due to their dense breast tissue.

MRI versus Mammography plus Ultrasound in Women at Intermediate Breast Cancer Risk: Study Design and Protocol of the MRIB Multicenter, Randomized, Controlled Trial

In women at high/intermediate lifetime risk of breast cancer (BC-LTR), contrast-enhanced magnetic resonance imaging (MRI) added to mammography ± ultrasound (MX ± US) increases sensitivity but decreases specificity. Screening with MRI alone is an alternative and potentially more cost-effective strategy. Here, we describe the study protocol and the characteristics of enrolled patients for MRIB feasibility, multicenter, randomized, controlled trial, which aims to compare MRI alone versus MX+US in women at intermediate breast cancer risk (aged 40–59, with a 15–30% BC-LTR and/or extremely dense breasts). Two screening rounds per woman were planned in ten centers experienced in MRI screening, the primary endpoint being the rate of cancers detected in the 2 arms after 5 years of follow-up. From July 2013 to November 2015, 1254 women (mean age 47 years) were enrolled: 624 were assigned to MX+US and 630 to MRI. Most of them were aged below 50 (72%) and premenopausal (45%), and 52% used oral contraceptives. Among postmenopausal women, 15% had used hormone replacement therapy. Breast and/or ovarian cancer in mothers and/or sisters were reported by 37% of enrolled women, 79% had extremely dense breasts, and 41% had a 15–30% BC-LTR. The distribution of the major determinants of breast cancer risk profiles (breast density and family history of breast and ovarian cancer) of enrolled women varied across centers.

Screening Breast MRI Primer: Indications, Current Protocols, and Emerging Techniques.

Breast dynamic contrast-enhanced MRI (DCE-MRI) is the most sensitive imaging modality for the detection of breast cancer. Screening MRI is currently performed predominantly in patients at high risk for breast cancer, but it could be of benefit in patients at intermediate risk for breast cancer and patients with dense breasts. Decreasing scan time and image interpretation time could increase cost-effectiveness, making screening MRI accessible to a larger group of patients. Abbreviated breast MRI (Ab-MRI) reduces scan time by decreasing the number of sequences obtained, but as multiple delayed contrast enhanced sequences are not obtained, no kinetic information is available. Ultrafast techniques rapidly acquire multiple sequences during the first minute of gadolinium contrast injection and provide information about both lesion morphology and vascular kinetics. Diffusion-weighted imaging is a noncontrast MRI technique with the potential to detect mammographically occult cancers. This review article aims to discuss the current indications of breast MRI as a screening tool, examine the standard breast DCE-MRI technique, and explore alternate screening MRI protocols, including Ab-MRI, ultrafast MRI, and noncontrast diffusion-weighted MRI, which can decrease scan time and interpretation time.

Cost-Effectiveness of Digital Breast Tomosynthesis vs. Abbreviated Breast MRI for Screening Women with Intermediate Risk of Breast Cancer-How Low-Cost Must MRI Be?

Simple SummaryWomen with dense breasts have an increased risk of breast cancer and a smaller likelihood of detection in conventional mammographic screening. It is an ongoing challenge of breast imaging techniques to increase sensitivity in dense breasts. Tomosynthesis, as well as abbreviated breast MR, intends to close the gap between optimal cancer detection rate and cost-effectiveness. The aim of this economic evaluation was to analyse the cost-effectiveness of these two imaging techniques in screening women of intermediate risk of breast cancer due to dense breasts. The model-based analysis revealed that abbreviated breast MRI can be considered cost-effective, being below the willingness to pay-threshold of $100,000 per quality-adjusted life-year gained.Background: Digital breast tomosynthesis (DBT) and abbreviated breast MRI (AB-MRI) offer superior diagnostic performance compared to conventional mammography in screening women with intermediate risk of breast cancer due to dense breast tissue. The aim of this model-based economic evaluation was to analyze whether AB-MRI is cost-effective in this cohort compared to DBT. Methods: Decision analysis and Markov simulations were used to model the cumulative costs and quality-adjusted life-years (QALYs) over a time horizon of 30 years. Model input parameters were adopted from recent literature. Deterministic and probabilistic sensitivity analyses were applied to test the stability of the model. Results: In the base-case scenario, the costs of an AB-MRI examination were defined to equal the costs of a full protocol acquisition. Two-yearly screening of women with dense breasts resulted in cumulative discounted costs of $8798 and $9505 for DBT and AB-MRI, and cumulative discounted effects of 19.23 and 19.27 QALYs, respectively, with an incremental cost-effectiveness ratio of $20,807 per QALY gained in the base-case scenario. By reducing the cost of an AB-MRI examination below a threshold of $241 in sensitivity analyses, AB-MRI would become cost-saving compared to DBT. Conclusion: In comparison to DBT, AB-MRI can be considered cost-effective up to a price per examination of $593 in screening patients at intermediate risk of breast cancer.

Cost-effectiveness of MR-mammography vs. conventional mammography in screening patients at intermediate risk of breast cancer - A model-based economic evaluation

PurposeThe aim of this study was to analyze the cost-effectiveness of screening patients of intermediate risk of breast cancer with MR-Mammography (MRM) versus conventional mammography (XM). MethodA decision model for both diagnostic modalities and a subsequent markov model for the simulation of follow-up costs and outcomes was developed. Input parameters were acquired from published literature for this markov modelling study. The expected cumulative costs and outcomes were calculated for both modalities in a 30-year timeframe in US-dollar ($) and quality-adjusted life years (QALYs). A deterministic sensitivity analysis and a probabilistic sensitivity analysis incorporating 30,000 Monte Carlo iterations were performed to investigate the model stability. ResultsIn total, XM with its consecutive treatments resulted in total costs of $ 5,492.68 and an average cumulative quality of life of 18.87 QALYs, compared to MRM with costs of $ 5,878.66 and 18.92 QALYs. The corresponding incremental cost-effectiveness ratio (ICER) for MRM was $ 8,797.60 per QALY - distinctly below international willingness-to-pay thresholds for cost-effectiveness. The results were confirmed within the limits of the sensitivity analyses. ConclusionsIn patients with intermediate risk for breast cancer due to their dense breast tissue, two-yearly screening with MRM may be considered as cost-effective.

Comprehensive analysis and ACMG‐based classification of CHEK2 variants in hereditary cancer patients

CHEK2 variants are associated with intermediate breast cancer risk, among other cancers. We aimed to comprehensively describe CHEK2 variants in a Spanish hereditary cancer (HC) cohort and adjust the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG-AMP) guidelines for their classification.First, three CHEK2 frequent variants were screened in a retrospective Hereditary Breast and Ovarian Cancer cohort of 516 patients. After, the whole CHEK2 coding region was analyzed by next-generation sequencing in 1848 prospective patients with HC suspicion. We refined ACMG-AMP criteria and applied different combined rules to classify CHEK2 variants and define risk alleles.We identified 10 CHEK2 null variants, 6 missense variants with discordant interpretation in ClinVar database, and 35 additional variants of unknown significance. Twelve variants were classified as (likely)-pathogenic; two can also be considered "established risk-alleles" and one as "likely risk-allele."The prevalence of (likely)-pathogenic variants in the HC cohort was 0.8% (1.3% in breast cancer patients and 1.0% in hereditary nonpolyposis colorectal cancer patients).Here, we provide ACMG adjustment guidelines to classify CHEK2 variants. We hope that this study would be useful for variant classification of other genes with low effect variants.

Cost-effectiveness of MR-mammography as a solitary imaging technique in women with dense breasts: an economic evaluation of the prospective TK-Study

ObjectivesTo evaluate the economic implications of our previous study on the use of MR-mammography (MRM) as a solitary imaging tool in women at intermediate risk due to dense breasts.BackgroundIn our previous study, we found MRM to be a specific diagnostic tool with high accuracy in patients with dense breasts representing a patient collective at intermediate risk of breast cancer. For this study, we examined whether MRM is an economical alternative.MethodsFor the determination of outcomes and costs, a decision model based on potential diagnostic results of MRM was developed. Quality of life was estimated in a Markov chain model distinguishing between the absence of malignancy, the presence of malignancy, and death. Input parameters were utilized from the prospective TK-Study. To investigate the economic impact of MRM, overall costs in € and outcomes of MRM in quality-adjusted life years (QALYs) were estimated. A deterministic sensitivity analysis was performed.ResultsMRM was associated with expected costs of 1650.48 € in the 5-year period and an expected cumulative outcome of 4.69 QALYs. A true positive diagnosis resulted in significantly lower costs and a higher quality of life when compared to the consequences of a false negative result. In the deterministic sensitivity analysis, treatment costs had more impact on overall costs than the costs of MRM. The total costs per patient remained below 2500 € in the 5-year period.ConclusionMRM, as a solitary imaging tool in patients at intermediate risk due to dense breasts, is economically feasible.Key Points• In patients with dense breasts (i.e., patients at intermediate risk of breast cancer), the relative cost of MR-mammography examinations only had moderate impact on overall costs.• This is due to cost-savings through the application of a sensitive imaging technique resulting in an optimized staging and therapy planning.• MR-mammography, unaccompanied by mammography or ultrasound in patients with dense breasts, was economically feasible in our analysis.

Clinical care of women with intermediate breast cancer risk

Clinical care of women with intermediate breast cancer risk

Contrast-Enhanced Spectral Mammography in Women With Intermediate Breast Cancer Risk and Dense Breasts.

The purpose of this study was to compare the diagnostic performance of contrast-enhanced spectral mammography (CESM) and ultrasound with that of standard digital mammography for breast cancer screening of women at intermediate risk who have dense breasts. In a retrospective cohort of 611 consecutively registered women who underwent screening CESM from 2012 to 2017, BI-RADS scores of the screening modalities were compared with actual disease status, assessed by histopathologic analysis or imaging follow-up. Sensitivity, specificity, and positive and negative predictive values were calculated. Among the 611 women included, 48.3% (295/611) had family or personal history of breast cancer, the BI-RADS breast density score was C or D in 93.1% (569/611). The mean follow-up period was 20 months. Mammography depicted 11 of 21 malignancies, sensitivity of 52.4%, specificity of 90.5% (534/590), positive predictive value of 16.4% (11/67), and negative predictive value of 98.2% (534/544). CESM depicted 19 of 21 malignancies, sensitivity of 90.5%, specificity of 76.1% (449/590), positive predictive value of 11.9% (19/160), and negative predictive value of 99.6% (449/451). Differences in sensitivity (p = 0.008) and specificity (p < 0.001) were statistically significant. Adjunct ultrasound revealed 73 additional suspicious findings; all were false-positive. In 39 women MRI was needed to assess screening abnormalities; two MRI-guided biopsies were performed and yielded one cancer. The incremental cancer detection rate of CESM was 13.1/1000 women (95% CI, 6.1-20.1). Of eight cancers seen only with CESM, seven were invasive (mean size, 9 mm; two of four cancers lymph-node positive). CESM was significantly more sensitive than standard digital mammography for detecting breast cancer in this screening population. No added benefit was found in the performance of ultrasound as an adjunct to CESM screens with negative results. CESM may be a valuable supplemental screening modality for women at intermediate risk who have dense breasts.

Mammography screening: A major issue in medicine

Mammography screening: A major issue in medicine

Abbreviated MRI and Accelerated MRI for Screening and Diagnosis of Breast Cancer.

Although published studies have revealed that magnetic resonance imaging (MRI) is by far the most effective imaging modality for cancer detection, it is currently considered cost-ineffective for screening women at an intermediate risk for breast cancer. The concept of an "abbreviated MRI" protocol has recently emerged as a possible solution for reducing the cost of MRI. The abbreviated MRI is a shortened version of the standard MRI, consisting of a single early phase dynamic contrast enhanced (DCE) series. Several clinical studies have shown that this MRI protocol would not affect sensitivity or specificity for breast MRI screening purposes. In clinical practice, morphologic evaluation and kinetic assessment are 2 major components of the interpretation process. However, kinetic assessment cannot be performed with the abbreviated protocol, because multiple sets of post-contrast images are necessary for the generation of kinetic curves. "Accelerated MRI" is a collective term for imaging techniques that acquire DCE-MR images in a very short time. Published studies suggest that the kinetic assessment during the very early post-contrast phase obtained with the accelerated MRI techniques is comparable to that with the standard MRI techniques. Applying accelerated MR techniques could potentially enhance the abbreviated MRI protocol in terms of diagnostic potential, while maintaining the shorter study time. Thus, the abbreviated MRI protocol associated with accelerated MRI techniques may provide value for screening and for diagnostic purposes.

Screening with magnetic resonance imaging, mammography and ultrasound in women at average and intermediate risk of breast cancer

BackgroundThe addition of MRI to mammography and ultrasound for breast cancer screening has been shown to improve screening sensitivity for high risk women, but there is little data to date for women at average or intermediate risk.MethodsTwo thousand nine hundred and ninety-five women, aged 40 to 65 years with no previous history of breast cancer were enrolled in a screening program, which consisted of two rounds of MRI, ultrasound and mammography, one year apart. Three hundred and fifty-six women had a CHEK2 mutation, 370 women had a first-degree relative with breast cancer (and no CHEK2 mutation) and 2269 women had neither risk factor. Subjects were followed for breast cancer for three years from the second screening examination.ResultsTwenty-seven invasive epithelial cancers, one angiosarcoma and six cases of DCIS were identified over the four-year period. Of the 27 invasive cancers, 20 were screen-detected, 2 were interval cancers, and five cancers were identified in the second or third follow-up year (i.e., after the end of the screening period). For invasive cancer, the sensitivity of MRI was 86%, the sensitivity of ultrasound was 59% and the sensitivity of mammography was 50%. The number of biopsies incurred by MRI (n = 156) was greater than the number incurred by mammography (n = 35) or ultrasound (n = 57). Of the 19 invasive cancers detected by MRI, 17 (89%) were also detected by ultrasound or mammography.ConclusionsIn terms of sensitivity, MRI is slightly better than the combination of mammography and ultrasound for screening of women at average or intermediate risk of breast cancer. However, because of additional costs incurred by MRI screening, and the small gain in sensitivity, MRI screening is probably not warranted outside of high-risk populations.

Recommendations for breast imaging follow-up of women with a previous history of breast cancer: position paper from the Italian Group for Mammography Screening (GISMa) and the Italian College of Breast Radiologists (ICBR) by SIRM.

Women who were previously treated for breast cancer (BC) are an important particular subgroup of women at intermediate BC risk. Their breast follow-up should be planned taking in consideration a 1.0–1.5 % annual rate of loco-regional recurrences and new ipsilateral or contralateral BCs during 15–20 years, and be based on a regional/district invitation system. This activity should be carried out by a Department of Radiology integrating screening and diagnostics in the context of a Breast Unit. We recommend the adoption of protocols dedicated to women previously treated for BC, with a clear definition of responsibilities, methods for invitation, site(s) of visits, methods for clinical and radiological evaluation, follow-up duration, role and function of family doctors and specialists. These women will be invited to get a mammogram in dedicated sessions starting from the year after the end of treatment. The planned follow-up duration will be at least 10 years and will be defined on the basis of patient’s age and preferences, taking into consideration organizational matters. Special agreements can be defined in the case of women who have their follow-up planned at other qualified centers. Dedicated screening sessions should include: evaluation of familial/personal history (if previously not done) for identifying high-risk conditions which could indicate a different screening strategy; immediate evaluation of mammograms by one or, when possible, two breast radiologists with possible addition of supplemental mammographic views, digital breast tomosynthesis, clinical breast examination, breast ultrasound; and prompt planning of possible further workup. Results of these screening sessions should be set apart from those of general female population screening and presented in dedicated reports. The following research issues are suggested: further risk stratification and effectiveness of follow-up protocols differentiated also for BC pathologic subtype and molecular classification, and evaluation of different models of survivorship care, also in terms of cost-effectiveness.

Screening with Magnetic Resonance Imaging in women at low and intermediate risk of breast Cancer

Patients and Methods From 2008 to 2011, 2995 women, aged 40 to 65 years with no previous history of breast cancer were enrolled in a prospective screening trial consisting of two annual rounds of MRI, ultrasound and mammography. 356 women had a CHEK2 mutation, 458 women had a first-degree relative with breast cancer and 2269 women had neither risk factor. Subjects were followed for incident cancer for one year from the date of the second screening examination.

Choices for Young Women at Intermediate Risk of Breast Cancer

Women with an inherited mutation in BRCA1 or BRCA2 have a lifetime risk of breast cancer that ap- proaches 80% [...]

Long‐term cohort study of women at intermediate risk of familial breast cancer: experiences of living at risk

To identify how women adjusted to living at intermediate risk of breast cancer six years following risk assessment, and what factors contributed to health service usage. Two studies are reported. Both report data from a cohort of women found at intermediate risk of breast cancer six years previously. In the first, 30 women with a range of Cancer Worry Scale (Lerman et al. Health Psychol 1991;10:259-267) scores were interviewed about how they lived with their risk of cancer and their use of health resources. The generalisability of these findings was tested in a sample of 387 women from the same cohort using psychometrically appropriate measures. In study 1, women scoring above the median baseline BCWS scale score were most likely to perceive their family history as a burden, exaggerate their susceptibility to breast cancer, not be reassured by genetic counselling, be focussed on the need for mammographic screening, and have a low reliance on breast self-examination. Key findings of the second study were that over a quarter of the cohort were experiencing at least moderate levels of intrusive worries. Worries were associated with perceptions of high personal vulnerability to and severity of cancer and breast cancer being highly salient. Women aged over 50 years with high levels of worry-related distress were most likely to request a mammogram. The high levels of distress in this cohort reinforce the need to provide appropriate interventions for vulnerable women following risk assessment.