Short-interval follow-up mammography versus immediate core biopsy of benign breast lesions: assessment of patient stress.

Abstract

OBJECTIVE. Thestress experienced bywomen undergoing surveillance mammographyfor benign lesions was compared with that experienced by women undergoing core biopsy of benign lesions. MATERIALSANDMETHODS.Aretrospective survey wasmailed towomen inwhomwere diagnosed breast abnormalities that were likely to be benign and that were stable at short-interval follow-up mammography (n = 174) or in whom a core biopsy of the breast was performed, with benign findings (n = 116). The survey included questions about stress related to the diagnostic experience as well as questions about who advised the women of the results of their breast imaging studies and about the information provided. RESULTS. Eighty eligible surveys werereceived fromthewomen whounderwent shortinterval follow-up mammography, and 58 surveys were received from the women who under went biopsies. The self-reported overall stress experienced by the women who underwent core biopsies was significantly greater (p < .001) than that reported by the group who were fol lowed up with mammography. The level of anxiety was not affected by the patient's percep tion of the probability that the lesion represented carcinoma. We found no significant differences in stress between women who discussed their mammogram results with a radiolo gistandwomenwho were notifiedby theirprimarycareprovider. CONCLUSION. Short-interval follow-up mammography continues tobeacceptable for theevaluationof lesionsthatareprobablybenign,evenwhen patientanxietyis considered.T he widespread use of screening mammography has resulted in the detectionof clinically occult and probably benign lesions in up to 11% of pa tients [ fl. Periodic mammographic surveil lance has been shown to be effective in the management of such abnormalities [1, 2]; however, the increasing availability of breast core biopsy has created controversy about the appropriate role of such biopsies in the evalua tion of these probably benign lesions. Series from the surgical literature have shown posi tive predictive values as low as 8% for core bi opsy [3,4]; authors of these studies have advocated the use of core biopsy instead of surveillance mammography.The suggestion has been made that needle biopsy should be used in lieu of periodic mammography to allay patient anxiety [5,6].Presumably, a definitive and timely diagnosis would entail less stress for the patient than would the uncertainty attending an extended period of surveillance.Becauseno previous empiric studies have focused on the relative stress experienced by women undergoing pe riodic mammographicsurveillanceas com pared with those undergoing immediate core biopsy, we conducted a retrospective, mailed survey to investigate this issue. Materials and MethodsA search of mammography reports from January I, 1994I, , until October 1, 1996, at two institutions yielded 174 women in whom had been diagnosed abnormalities that were probably benign (category lesions under the Breast Imaging Reporting andData System of the AmericanCollege of Radiology [7]) and that were stable at shor...

Probably Benign Lesions at Screening Breast US in a Population with Elevated Risk: Prevalence and Rate of Malignancy in the ACRIN 6666 Trial

“…The presence of simple cysts was recorded by breast. Mass shape, 3 lesions are common at work-up of screening mammographic abnormalities, occurring in 6% of examinations (16,(25)(26)(27), and despite their low malignancy rate, they require additional follow-up or even biopsy that results in substantial patient anxiety (28). Little has been written about the prevalence or outcomes of BI-RADS category 3 lesions detected at screening US (29).…”

“…The cost of additional studies or biopsy in these probably benign lesions can be substantial (28,(49)(50)(51). Since BI-RADS category 3 lesions have a low malignancy rate (0.8%; 95% CI: 0.3%, 1.7%) (six of 745 lesions) and since only one (0.1%) lesion had suspicious changes at short-interval follow-up and one (0.1%) lesion had suspicious…”

Older Women’s Experience with a Benign Breast Biopsy—A Mixed Methods Study

“…Previous studies have found that 33 to 63 % of women report increased concerns about breast cancer after a falsepositive mammogram. 12,21,45 Our numbers may be slightly lower due to the age of our participants and that 35 % had experienced a benign breast biopsy before. In addition, older women diagnosed with atypia tended to report more anxiety about future mammograms.…”

“…7,8 While it is well known that undergoing a breast biopsy is stressful for younger women, it is not known how this experience affects older women. [9][10][11][12][13][14] To better understand and improve older women's experience with a benign breast biopsy, we interviewed women aged 65 and older at the time of breast biopsy before they knew their results and 6 months later if not diagnosed with breast cancer. We used both quantitative and qualitative methods to better understand and to develop a conceptual framework of older women's experience with a benign breast biopsy.…”

Psychological impact of recall in high-risk breast MRI screening

“…As is the case with mammography, these women would likely exhibit greater stress than those recalled for imaging alone [32]. However, the high diagnostic yield of biopsy likely balances any untoward psychological effects.…”