Skip to main content

Advertisement

SpringerLink
Log in

Decision quality and regret with treatment decisions in women with breast cancer: Pre-operative breast MRI and breast density

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

We evaluated self-report of decision quality and regret with breast cancer surgical treatment by pre-operative breast MRI use in women recently diagnosed with breast cancer.

Methods

We conducted a survey with 957 women aged 18 + with stage 0-III breast cancer identified in the Breast Cancer Surveillance Consortium. Participants self-reported receipt of pre-operative breast MRI. Primary outcomes were process measures in the Breast Cancer Surgery Decision Quality Instrument (BCS-DQI) (continuous outcome) and Decision Regret Scale (dichotomized outcome as any/none). Generalized estimating equations with linear and logit link were used to estimate adjusted associations between breast MRI and primary outcomes. All analyses were also stratified by breast density.

Results

Survey participation rate was 27.9% (957/3430). Study population was primarily > 60 years, White, college educated, and diagnosed with early-stage breast cancer. Pre-operative breast MRI was reported in 46% of women. A higher proportion of women who were younger age (< 50 years), commercially insured, and self-detected their breast cancer reported pre-operative breast MRI use. In adjusted analysis, pre-operative breast MRI use compared with no use was associated with a small but statistically significantly higher decision quality scores (69.5 vs 64.7, p-value = 0.043). Decision regret did not significantly differ in women who reported pre-operative breast MRI use compared with no use (54.2% v. 48.7%, respectively, p-value = 0.11). Study results did not vary when stratified by breast density for either primary outcome.

Conclusions and relevance

Breast MRI use in the diagnostic work-up of breast cancer does not negatively alter women’s perceptions of surgical treatment decisions in early survivorship.

Clinical Trials Registration Number: NCT03029286.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The datasets generated during and analyzed during the current study are not publicly available until remaining analyses are complete but may be available on reasonable request from the senior author Dr. Anna Tosteson at anna.n.a.tosteson@dartmouth.edu.

References

  1. Killelea BK, Long JB, Chagpar AB et al (2013) Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer. Breast Cancer Res Treat 141(1):155–163. https://doi.org/10.1007/s10549-013-2656-1

    Article  PubMed  PubMed Central  Google Scholar 

  2. Henderson LM, Weiss J, Hubbard RA et al (2016) Factors associated with preoperative magnetic resonance imaging use among Medicare beneficiaries with nonmetastatic breast cancer. Breast J 22(1):24–34. https://doi.org/10.1111/tbj.12522

    Article  PubMed  Google Scholar 

  3. National Comprehsenive Cancer Network. National Comprehensive Cancer Network: NCCN Guidelines Version 1.2021 National Comprehensive Cancer Network. https://jnccn.org/abstract/journals/jnccn/16/3/article-p310.xml. Accessed 1 Mar 2021

  4. Houssami N, Ciatto S, Macaskill P et al (2008) Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. Meta-analysis review. J Clin Oncol 26(19):3248–3258. https://doi.org/10.1200/JCO.2007.15.2108

    Article  PubMed  Google Scholar 

  5. Onega T, Zhu W, Weiss JE et al (2018) Preoperative breast MRI and mortality in older women with breast cancer. Breast Cancer Res Treat 170(1):149–157. https://doi.org/10.1007/s10549-018-4732-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Young P, Kim B, Malin JL (2012) Preoperative breast MRI in early-stage breast cancer. Breast Cancer Res Treat 135(3):907–912. https://doi.org/10.1007/s10549-012-2207-1

    Article  PubMed  Google Scholar 

  7. Liberman L (2006) Breast MR imaging in assessing extent of disease. Magn Reson Imaging Clin N Am. 14(3):339–49. https://doi.org/10.1016/j.mric.2006.07.007

    Article  PubMed  Google Scholar 

  8. Morrow M, Freedman G (2006) A clinical oncology perspective on the use of breast MR. Magn Reson Imaging Clin N Am. 14(3):363–78. https://doi.org/10.1016/j.mric.2006.07.006

    Article  PubMed  Google Scholar 

  9. Smith RA (2007) The evolving role of MRI in the detection and evaluation of breast cancer. N Engl J Med 356(13):1362–1364. https://doi.org/10.1056/NEJMe078006

    Article  CAS  PubMed  Google Scholar 

  10. Montgomery M, McCrone SH (2010) Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review. J Adv Nurs 66(11):2372–2390. https://doi.org/10.1111/j.1365-2648.2010.05439.x

    Article  PubMed  Google Scholar 

  11. Bond M, Pavey T, Welch K et al (2013) Systematic review of the psychological consequences of false-positive screening mammograms. Health Technol Assess. 17(13):1–170. https://doi.org/10.3310/hta17130

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Onega T, Tosteson AN, Weiss J et al (2016) Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis. BMC Health Serv Res. 16:76. https://doi.org/10.1186/s12913-016-1317-6

    Article  PubMed  PubMed Central  Google Scholar 

  13. Holland K, van Gils CH, Mann RM, Karssemeijer N (2017) Quantification of masking risk in screening mammography with volumetric breast density maps. Breast Cancer Res Treat 162(3):541–548. https://doi.org/10.1007/s10549-017-4137-4

    Article  PubMed  PubMed Central  Google Scholar 

  14. Raghavendra A, Sinha AK, Le-Petross HT et al (2017) Mammographic breast density is associated with the development of contralateral breast cancer. Cancer 123(11):1935–1940. https://doi.org/10.1002/cncr.30573

    Article  CAS  PubMed  Google Scholar 

  15. Breast Cancer Surveillance Consortium. Breast Cancer Surveillance Consortium Homepage. http://www.bcsc-research.org/. Accessed 20 Aug 2019

  16. Ballard-Barbash R, Taplin SH, Yankaskas BC et al (1997) Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. AJR Am J Roentgenol 169(4):1001–1008. https://doi.org/10.2214/ajr.169.4.9308451

    Article  CAS  PubMed  Google Scholar 

  17. Griffin JM, Simon AB, Hulbert E et al (2011) A comparison of small monetary incentives to convert survey non-respondents: a randomized control trial. BMC Med Res Methodol. 11:81. https://doi.org/10.1186/1471-2288-11-81

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sepucha KR, Langford AT, Belkora JK et al (2019) Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients. Med. Decision Making 39(6):642–650. https://doi.org/10.1177/0272989x19862545

    Article  Google Scholar 

  19. Lee CN, Chang Y, Adimorah N et al (2012) Decision making about surgery for early-stage breast cancer. J Am Coll Surg 214(1):1–10. https://doi.org/10.1016/j.jamcollsurg.2011.09.017

    Article  PubMed  Google Scholar 

  20. Sepucha KR, Belkora JK, Chang Y et al (2012) Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery. BMC Med Inform Decis Mak. 12:51. https://doi.org/10.1186/1472-6947-12-51

    Article  PubMed  PubMed Central  Google Scholar 

  21. O'Connor A. User Manual-Decision Regret Scale. Document on the Internet. Ottawa: Ottawa Hospital Research Institute. Updated 2003. http://decisionaid.ohri.ca/docs/develop/User_Manuals/UM_Regret_Scale.pdf. Accessed 1 Mar 2021

  22. Lerman C, Trock B, Rimer BK, Jepson C, Brody D, Boyce A (1991) Psychological side effects of breast cancer screening. Health Psychol 10(4):259–267. https://doi.org/10.1037//0278-6133.10.4.259

    Article  CAS  PubMed  Google Scholar 

  23. O’Connor AM (1995) Validation of a decisional conflict scale. Med Decis Mak 15(1):25–30. https://doi.org/10.1177/0272989X9501500105

    Article  CAS  Google Scholar 

  24. D’Orsi C, Sickles E, Mendelson E, Morris E et al (2013) ACR BI-RADS atlas, breast imaging reporting and data system, 5th edn. American College of Radiology, NY

    Google Scholar 

  25. Sepucha K, Feibelmann S, Chang Y, Hewitt S, Ziogas A (2015) Measuring the quality of surgical decisions for Latina breast cancer patients. Health Expect 18(6):2389–2400. https://doi.org/10.1111/hex.12207

    Article  PubMed  Google Scholar 

  26. Waljee JF, Rogers MA, Alderman AK (2007) Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? J Clin Oncol 25(9):1067–1073. https://doi.org/10.1200/JCO.2006.08.5472

    Article  PubMed  Google Scholar 

  27. Durand MA, Yen RW, O’Malley AJ et al (2021) What matters most: Randomized controlled trial of breast cancer surgery conversation aids across socioeconomic strata. Cancer 127(3):422–436. https://doi.org/10.1002/cncr.33248

    Article  PubMed  Google Scholar 

  28. Manne S, Smith B, Mitarotondo A, Frederick S, Toppmeyer D, Kirstein L (2019) Decisional conflict among breast cancer patients considering contralateral prophylactic mastectomy. Patient Educ Couns 102(5):902–908. https://doi.org/10.1016/j.pec.2018.12.008

    Article  PubMed  Google Scholar 

  29. Parker PA, Peterson SK, Shen Y et al (2018) Prospective study of psychosocial outcomes of having contralateral prophylactic mastectomy among women with nonhereditary breast cancer. J Clin Oncol 36(25):2630–2638. https://doi.org/10.1200/jco.2018.78.6442

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bleicher RJ, Ciocca RM, Egleston BL et al (2009) Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2:180–7. https://doi.org/10.1016/j.jamcollsurg.2009.04.010

    Article  Google Scholar 

  31. Hill DA, Haas JS, Wellman R et al (2018) Utilization of breast cancer screening with magnetic resonance imaging in community practice. J Gen Intern Med 33(3):275–283. https://doi.org/10.1007/s11606-017-4224-6

    Article  PubMed  Google Scholar 

  32. Onega T, Zhu W, Kerlikowske K et al (2021) Preoperative MRI in breast cancer: effect of breast density on biopsy rate and yield. Breast Cancer Res Treat. https://doi.org/10.1007/s10549-021-06418-x

    Article  PubMed  Google Scholar 

  33. Gast KC, Cathcart-Rake EJ, Norman A et al (2019) Accuracy of self-reported cancer treatment data in young breast cancer survivors. J Patient Rep Outcomes. 3(1):24. https://doi.org/10.1186/s41687-019-0114-5

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Research reported in this work was funded through a Patient-Centered Outcomes Research Institute (PCORI) award (PCS-1504-30370). Data collection for this research was additionally supported by the Breast Cancer Surveillance Consortium with funding from the National Cancer Institute (P01CA154292, U54CA163303), the Agency for Health Research and Quality (R01 HS018366-01A1), the UC Davis Clinical and Translational Science Center, the UC Davis Comprehensive Cancer Center, and the Placer County Breast Cancer Foundation. The collection of cancer data used in this study was supported in part by several U.S. state public health departments and cancer registries (https://www.bcsc-research.org/about/work-acknowledgement). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee, nor those of the National Cancer Institute or the National Institutes of Health. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. You can learn more about the BCSC at: http://www.bcsc-research.org/.

Author information

Authors and Affiliations

  1. Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA

    Karen J. Wernli, Diana S. M. Buist & Diana L. Miglioretti

  2. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA

    Rebecca E. Smith, Wenyan Zhao, Karen Schifferdecker & Anna N. A. Tosteson

  3. University of North Carolina-Chapel Hill, Chapel Hill, NC, USA

    Louise M. Henderson & Danielle D. Durham

  4. University of California-San Francisco, San Francisco, CA, USA

    Celia Kaplan & Karla Kerlikowske

  5. University of California-Davis, Davis, CA, USA

    Diana L. Miglioretti, Gloria Jackson-Nefertiti, Jill Budesky & Dianne Johnson

  6. University of Utah, Salt Lake City, UT, USA

    Tracy Onega

  7. Advocate Aurora Health Care, Park Ridge, IL, USA

    Nila H. Alsheik

  8. University of Vermont, Burlington, VT, USA

    Brian L. Sprague

Authors
  1. Karen J. Wernli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebecca E. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Louise M. Henderson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenyan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Danielle D. Durham
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karen Schifferdecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Celia Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Diana S. M. Buist
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Karla Kerlikowske
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Diana L. Miglioretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tracy Onega
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Nila H. Alsheik
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Brian L. Sprague
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Gloria Jackson-Nefertiti
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Jill Budesky
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Dianne Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Anna N. A. Tosteson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceived and designed the analysis: KJW, RES, LMH, WZ, DDD, KS, CK, ANAT. Collected the data: RES, LMH, DSMB, KK, DLM, TO, NHA, BLS, ANAT. Contributed data or analysis tools: KJW, RES, LMH, DSMB, KK, DLM, TO, NHA, BLS, ANAT. Performed the analysis: RES, WZ. Wrote the paper: KJW, RES, LMH, WZ, DDD, KS, CK, DSMB, KK, DLM, TO, NHA, BLS, GNJ, JB, DJ, and ANAT.

Corresponding author

Correspondence to Karen J. Wernli.

Ethics declarations

Conflicts of interest

Karla Kerlikowske reports being a nonpaid consultant for GRAIL for STRIVE Study. Diana Miglioretti reports receiving an Honorarium from the Society for Breast Imaging for giving a keynote lecture. All other study authors report no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wernli, K.J., Smith, R.E., Henderson, L.M. et al. Decision quality and regret with treatment decisions in women with breast cancer: Pre-operative breast MRI and breast density. Breast Cancer Res Treat 194, 607–616 (2022). https://doi.org/10.1007/s10549-022-06648-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-022-06648-7

Keywords

Search

Navigation