Breast MRI during workup of DCIS can spur anxiety in women

2019 01 23 20 13 5254 Patient African American Woman 400

Women undergoing breast MRI for evaluation of ductal carcinoma in situ (DCIS) experience anxiety as well as physical discomfort and may benefit from counseling prior to imaging, according to a new study published on November 2 in JAMA Network Open.

Breast MRI in addition to mammography in women diagnosed with DCIS prior to surgery was significantly associated with worry about cancer, according to the research, which was an ancillary study of 75 U.S. centers coordinated by the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ACRIN) cancer research group E4112.

"Understanding the potential quality-of-life reduction associated with MRI, especially when used in combination with mammography, may allow development of targeted interventions to improve the patient experience," wrote a team led by Dr. Ruth Carlos, assistant chair for clinical research at the University of Michigan.

Assessing well-being

The study was undertaken to assess the effect of breast MRI on health-related quality of life (HRQOL) using the tumor morbidities index (TMI), a seven-item questionnaire that evaluates temporary changes in well-being before, during, and after diagnostic imaging exams. The TMI instrument evaluates mental concerns separately from physical pain discomfort.

The TMI has been used to evaluate other types of imaging studies, such as pelvic MRI, but its application in breast MRI is relatively new. Little has been known about the negative physical and emotional effects on overall wellbeing and function of breast MRI, the authors noted.

"Presumed morbidity associated with these tests is particularly important for patients with cancer, who are at increased risk for negative emotional outcomes, including fear of cancer recurrence," Carlos et al wrote.

The researchers surveyed 355 women who had bilateral breast MRI scans after mammography and ahead of wide local excision for DCIS. The patients did not have microinvasive or invasive disease. With the TMI, 0 is the lowest score, meaning the worst experience, and 100 is the highest, meaning the perfect experience.

Out of 355 women, 244 (69%) completed the quality-of-life testing. They were asked to assess the degree to which they had pain and/or discomfort and fear or anxiety. The mean TMI with breast MRI was 85.9. Results showed that 30% of patients experienced some pain or discomfort before the exam, and 54% had some pain or discomfort during imaging (see table).

Furthermore, 46% reported at least some fear or anxiety prior to the study and 43% had some fear or anxiety during. The authors described the patient self-reported changes in well-being during breast exams as "clinically meaningful."

"A diagnostic pathway with breast MRI after diagnostic mammography for DCIS increased the testing burden by 15.7% compared with mammography alone," Carlos and colleagues wrote. "Cancer worry was significantly associated with greater MRI testing burden and greater cumulative burden of a mammography and breast MRI diagnostic pathway."

Impact of breast MRI on self-reported quality of life in DCIS patients
  Before MRI During MRI
None 68% 36%
Some 30% 54%
A lot 2% 8%
Extreme 0.4% 2%
Fear or anxiety
None 42% 51%
Some 46% 43%
A lot 9% 5%
Extreme 3% 1%

After the MRI exam and before surgery, 86% reported no mental discomfort, and 87% reported no physical discomfort.

Carlos and colleagues described the use of MRI in pretreatment planning for DCIS as "controversial," and wrote that testing is not benign and may result in fear and anxiety unrelated to the underlying diagnosis. Younger patients in particular generally experience more anxiety and depression. However, education and counseling could improve the overall testing experience, the authors suggested.

"Targeted interventions to mitigate fear of cancer and recurrence early after diagnosis may improve HRQOL outcomes including diagnostic testing burden," Carlos et al concluded.

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