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

Karen J. Wernli, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA. Karen.J.Wernli@kp.org.
Rebecca E. Smith, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
Louise M. Henderson, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Wenyan Zhao, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
Danielle D. Durham, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Karen Schifferdecker, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
Celia Kaplan, University of California-San Francisco, San Francisco, CA, USA.
Diana S. Buist, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.Follow
Karla Kerlikowske, University of California-San Francisco, San Francisco, CA, USA.
Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.
Tracy Onega, University of Utah, Salt Lake City, UT, USA.
Nila H. Alsheik, Advocate Aurora HealthFollow
Brian L. Sprague, University of Vermont, Burlington, VT, USA.
Gloria Jackson-Nefertiti, University of California-Davis, Davis, CA, USA.
Jill Budesky, University of California-Davis, Davis, CA, USA.
Dianne Johnson, University of California-Davis, Davis, CA, USA.
Anna N. Tosteson, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.

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.

Document Type

Article

PubMed ID

35723793

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