Health-related quality of life among high-risk women in an MRI surveillance study

Abstract

1522 Background: The quality of life (QOL) and psychological impact of incorporating MRI into breast cancer screening programs for high-risk women (HRW) has not been well studied. Psychological and biological risk factors, e.g. cancer history, BRCA mutation, imaging recall, generalized anxiety or clinical depression may mediate QOL outcomes. Methods: 100 HRW undergoing intensive surveillance including yearly mammography, semiannual breast ultrasound and breast MRI have completed QOL (SF-36), anxiety (STAI) and depression (Beck) questionnaires at semi-annual visits. 56 HRW have completed 3 screenings. Differences in QOL measures over time were evaluated using longitudinal regression models. Differences between participants and population norms (PN), women with/without a history of cancer and with/without a BRCA mutation were assessed using t-tests. Results: QOL scores increased over time and were statistically significant for the general health (GH) subscale (p=0.016). All QOL subscales were higher than PN at baseline and were significantly higher than PN at 12 months. Mean GH score at 12 months = 80.0, PN 72.7 (SD14.2, p<0.01). Mean mental health score at 12 months = 78.9, PN 73.4 (SD14.9, p<0.01). At baseline, BRCA carriers had lower QOL scores than non-carriers and women with a history of cancer had higher QOL scores than unaffected participants, although these differences were not statistically significant. Conclusions: These data suggest that intensive breast cancer screening incorporating breast MRI may have a positive effect among HRW. Continued enrollment will allow for multi-variate characterization of psychological and biological predictors of change in QOL and psychological well-being among high-risk women undergoing intensive screening. No significant financial relationships to disclose.

Stress, anxiety, and health-related quality of life in BRCA1/2-positive women with and without cancer: A comparison of four US female samples

“…Stress and anxiety appear most often among those actively undergoing genetic testing or counseling ( Moyer, 2014 ) and afterward due to prophylactic treatment since their stress has been found to be highest due to test results and surgeries for subsequent risk reduction ( Wenzel et al, 2012 ). BRCA1/2 -positive women who have received clear surveillance results (no abnormalities seen), for instance, concurrently have reported better HRQoL scores ( Bradbury et al, 2007 ). As shown in previous literature by Metcalfe and colleagues ( Metcalfe et al, 2015 ), HRQoL appears to be fluid over time, relative to when choices are made regarding these treatments and if any cancer diagnosis occur.…”

“…Although genetic testing/counseling provides preventive opportunities for risk management, it has been shown to decrease HRQoL in response to increases in anxiety/stress as well as the life-changing nature of what a positive genetic test means for not only the individual but the family unit ( Harmsen et al, 2015 ). Research has demonstrated the importance of understanding HRQoL among BRCA1/2 -positive individuals regarding prophylactic (preventive) decision-making and ongoing surveillance despite increased in-person provider communication and knowledge ( Connors et al, 2014 , Dean, 2016 ) and adverse psychosocial reactions to these genetic testing/counseling and results, surgeries, and surveillance measures ( Bradbury et al, 2007 , Jones et al, 2020 ). Previous research, however, does not examine potential differences among subpopulations of BRCA1/2 -positive samples, such as those with cancer recurrence(s) or those without cancer, due to relatively small sample sizes that have most notably qualitative decision-making and family interactions thus limiting implications assisting medical professionals working directly with these populations ( Donnelly et al, 2013 , Rowland et al, 2016 ).…”