Frequency of Breast Cancer Thoughts and Lifetime Risk Estimates: A Multi-Institutional Survey of Women Undergoing Screening Mammography

Grimm, Lars J.; Shelby, Rebecca A.; Knippa, Emily E.; Langman, Eun L.; Miller, Lauren S.; Whiteside, Beth A.; Soo, Mary Scott

doi:10.1016/j.jacr.2018.12.031

Cited by 4 publications

(8 citation statements)

References 25 publications

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“…Interestingly, 64% of biopsies in our cohort were recorded as patient‐prompted biopsies, which likely indicates the perception of inflated cancer risk by the patients associated with BI‐RADS category 3 lesions. This finding is in keeping with prior studies which showed 32.8% of participants with BIRADS 3 lesion estimating breast cancer which can cause disproportionate anxiety among patients leading to unwarranted biopsy decision 9,12 . These results indicate that there is a discrepancy between the group of lesions that are biopsied more and that are true positives.…”

Section: Discussionmentioning

confidence: 92%

“…However, the probably benign category remains controversial due to high interobserver variability, patient anxiety, and low compliance with the standard imaging surveillance protocol 9 . In addition, the malignancy rate of BI‐RADS category 3 lesions ranges widely (0.5%–10.1%) in the literature 11–18 . Although, more recently Berg et al (2020) assessed malignancy rate of BI‐RADS 3 lesions to be 1.86% 19 …”

Section: Introductionmentioning

confidence: 99%

“…Despite a low malignancy rate, up to 46% of BI‐RADS category 3 lesions (range: 3.5%–46%) undergo biopsy 11,12,17,23,25–27 . It is unknown what primarily drives the biopsies in BI‐RADS category 3 lesions.…”

Section: Introductionmentioning

confidence: 99%

“…9 In addition, the malignancy rate of BI-RADS category 3 lesions ranges widely (0.5%-10.1%) in the literature. [11][12][13][14][15][16][17][18] Although, more recently Berg et al (2020) assessed malignancy rate of BI-RADS 3 lesions to be 1.86%. 19 Despite a low malignancy rate, up to 46% of BI-RADS category 3 lesions (range: 3.5%-46%) undergo biopsy.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Imaging and Biopsy of BI‐RADS Category 3 Lesions

Polat

Merchant

Hayes

et al. 2022

J of Ultrasound Medicine

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Objectives To identify biopsy rates and indications for BI‐RADS 3 lesions in a large cohort of patients and compare with follow‐up compliance and malignancy outcomes. Methods We retrospectively reviewed all BI‐RADS category‐3 lesions seen on mammography and/or ultrasound between 2013 and 2015. Patient age, lesion size, follow‐up rates at 6‐, 12‐, and 24‐months were collected. Biopsy timing, indication, and outcomes (malignant vs benign) were recorded using at least 2‐year follow‐up or biopsy pathology as endpoint. Results Of 2319 BI‐RADS 3 lesions in 2075 women analyzed, biopsy was performed in 173 (7.5%). Most biopsies were performed upfront (99, 57.2%), followed by at 6 (44, 25.4%), 12 (21, 12.1%), and 24‐month follow‐up (9, 5.2%; P < .001). Palpable (P < .001) and larger (median 1.4 vs 1.0 cm, P < .001) lesions in women <40 years (15.2% vs 4.8%, P < .001) were more likely to undergo biopsy. Most biopsies were prompted by patient/physician desire (64.5%, P < .001). Of 783 lesions with available endpoint, 5 (0.6%) were cancer. All cancers were identified either at presentation (in 0–5 months, n = 1) or 6‐month follow‐up (in 5–9 months, n = 4) with biopsy prompted by either morphology change (n = 3) or lesion growth (n = 2). Of the 1855 lesions which were expected for follow up, only 310 (16.7%) underwent all follow‐ups, while 482 (26.1%) had two, 489 (26.5%) one, and 565 (30.6%) had no follow‐up. Conclusions In our cohort, BI‐RADS category 3 lesions had significantly higher biopsy rates compared with the small malignancy rate, all of which were identified at baseline or first follow‐up. Overall patient follow‐up compliance low. Imaging follow‐up, especially at first 6‐month time point, should be encouraged in BI‐RADS 3 lesions, instead of upfront biopsies.

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Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcome of Imaging and Biopsy of BI‐RADS Category 3 Lesions

Polat

Merchant

Hayes

et al. 2022

J of Ultrasound Medicine

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“…Often a hybrid approach is needed. Grimm et al used a combination of a published scale to quantify anxiety [12] and new breast cancer-specific items with feedback from patients, physicians, technologists, and a psychologist [13]. Ideally, formal pretesting and evaluation for internal reliability should be performed when new items are generated, as Yin and colleagues described in detail in their investigation of physician opinions on optimal reporting of multipart imaging examinations [14].…”

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confidence: 99%

Survey Research in Radiology: “Strongly Agree”

Shankar

Maturen

2019

Journal of the American College of Radiology

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Validation Study on Risk-Reduction Activities after Exposure to a Personalized Breast Cancer Risk-Assessment Education Tool in High-Risk Women in the WISDOM Study

Esserman

Wang

Che

et al. 2023

Preprint

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We performed a 318-participant validation study of an individualized risk assessment tool in women identified as having high- or highest-risk of breast cancer in the personalized arm of the Women Informed to Screen Depending on Measures of risk (WISDOM) trial. Per protocol, these women were educated about their risk and risk reducing options using the Breast Health Decisions (BHD) tool, which uses patient-friendly visuals and 8th grade reading level language to convey risk and prevention options. Prior to exposure to the educational tool, 4.7% of women were already taking endocrine risk reduction, 38.7% were reducing alcohol intake, and 62.6% were exercising. Three months after initial use of BHD, 8.4% of women who considered endocrine risk reduction, 33% of women who considered alcohol reduction, and 46% of women who considered exercise pursued the risk-reducing activities. Unlike lifestyle interventions which are under the control of the patient, additional barriers at the level of the healthcare provider may be impeding the targeted use of endocrine risk reduction medications in women with elevated breast cancer risk.

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Frequency of Breast Cancer Thoughts and Lifetime Risk Estimates: A Multi-Institutional Survey of Women Undergoing Screening Mammography

Cited by 4 publications

References 25 publications

Outcome of Imaging and Biopsy of BI‐RADS Category 3 Lesions

Outcome of Imaging and Biopsy of BI‐RADS Category 3 Lesions

Survey Research in Radiology: “Strongly Agree”

Validation Study on Risk-Reduction Activities after Exposure to a Personalized Breast Cancer Risk-Assessment Education Tool in High-Risk Women in the WISDOM Study

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