Preferences and Attitudes Regarding Adjunct Breast Cancer Screening Among Patients with Dense Breasts

Abstract

Objective New breast screening modalities are being investigated to address the need for more sensitive breast cancer screening in women with dense breasts. We investigated the preferences and attitudes of these patients regarding adjunct screening modalities to help evaluate the acceptability of these exams. Methods In this institutional review board–approved prospective study, patients with dense breasts on their prior mammogram were invited to complete a survey. Patients were asked to estimate their personal breast cancer risk compared with peers, indicate their level of concern related to screening callbacks, radiation exposure, and intravenous (IV) contrast allergies, and identify which factors might deter them from getting adjunct screening exams. Results Five hundred eight patients with dense breasts presenting for screening mammography completed surveys. While most patients (304/508, 59.9%) felt it was likely or very likely that cancer could be missed on their mammogram, only 8.9% (45/508) had undergone adjunct screening exams in the past 3 years. The most commonly cited deterrents to adjunct screening were cost (340/508, 66.9%), pain (173/508, 34.1%), and concern that adjunct screening could lead to additional procedures (158/508, 31.1%). When asked to select among three hypothetical breast cancer screening modalities, patients strongly preferred the more sensitive examination, even if this involved greater cost (162/508, 31.9%) or IV-contrast administration (315/508, 62.0%). Conclusion Our data suggest that patients with dense breasts prefer adjunct screening exams that are both sensitive and inexpensive, although an increase in sensitivity could outweigh additional cost or even IV-line placement.

Patient Characteristics Associated With Patient-Reported Deterrents to Adjunct Breast Cancer Screening of Patients With Dense Breasts

“…Another key finding of our study was that younger patient age was the only predictor variable independently associated with concern about examination cost, which was by far the most common deterrent (66.9%) to adjunct screening [9].…”

“…A recent prospective survey of women with dense breasts who presented for screening mammography was conducted to better understand patient preferences and attitudes toward adjunct screening [9]. This study found that, while the majority of these patients (60%) felt that it was likely or very likely that breast cancer could be missed on their mammogram due to having dense breasts, a small percentage (9%) reported having undergone adjunct screening examinations within the preceding three years.…”

“…This incongruence between understanding the limitations of mammography and pursuing adjunct screening suggested that, with appropriate education, more patients may be amenable to adjunct screening than are currently receiving it. Such patient education would be particularly effective if focused on addressing the most commonly cited deterrent factors, which in that survey were examination cost (66.9%), pain (34.1%), and a concern that adjunct screening could lead to additional procedures (31.3%) [9].…”

“…A cross-sectional patient survey study was conducted from March 2017 to February 2018 to evaluate the preferences and attitudes of women with dense breasts toward adjunct breast cancer screening. The survey methodology and summary statistics from the survey have been previously reported [9]. Briefly, women with heterogeneously dense or extremely dense breasts on their most recent prior mammogram report who presented for annual screening mammography were invited to complete a survey (Table 1).…”

“…Surveys were completed by 508 women with dense breasts presenting for annual screening mammography, as previously reported [9] ( Table 1) (Table 2). A "strong" (first-degree relative) family history of breast cancer was reported by 21% of patients and "some" (non-firstdegree relatives only) family history of breast cancer was reported by 27% of patients.…”