title: Opinions of women with high inherited breast cancer risk about prophylactic mastectomy: an initial evaluation from a screening trial including magnetic resonance imaging and ductal lavage.
abstract: OBJECTIVE
  Prophylactic mastectomy (PM) is often considered, but variably chosen by women at high inherited risk of breast cancer; few data exist on patient tolerance of intensive breast screening as an alternative to PM. We performed an evaluation of high-risk women's tolerance of a breast screening protocol using clinical breast examination, mammography, breast magnetic resonance imaging (MRI) and ductal lavage (DL), and of change in attitudes toward PM after screening.
  
  
  METHODS
  A questionnaire assessing tolerance of screening procedures and change in opinion towards PM was designed and administered to 43 study participants, after a median follow-up of 13 months. Responses were evaluated according to patient characteristics, including type of study-prompted interventions, BRCA mutation status, and prior history of cancer, via univariate analysis.
  
  
  RESULTS
  Most patients [85.3% (68.9-95.1%)] were more opposed or unchanged in their attitudes towards PM after study participation, with only 14.7% (5.0-31.1%) less opposed (P = 0.017) despite a short-interval follow-up MRI rate of 71.7% and a biopsy rate of 37%. Lower rates of maximal discomfort were reported with mammogram [2.8% (0-14.5%)] and MRI [5.6% (0-18.7%)] than with DL [28.6% (14.6-46.3%)], with P = 0.035.
  
  
  CONCLUSIONS
  Most high-risk women tolerated intensive breast screening well; they were not more inclined towards PM after participating. Future studies should prospectively evaluate larger numbers of high-risk women via multivariate analysis, to determine characteristics associated with preference for breast screening vs. PM.
authors.affiliation: Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305-5820, USA. akurian@stanford.edu
authors.forename: Allison W
authors.initials: AW
authors.lastname: Kurian
authors.forename: Anne-Renee
authors.initials: AR
authors.lastname: Hartman
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Mills
authors.forename: James M
authors.initials: JM
authors.lastname: Ford
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Daniel
authors.forename: Sylvia K
authors.initials: SK
authors.lastname: Plevritis
mesh_terms: D000328:Adult; D001940:Breast / Q000166:cytology / Q000601:surgery*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D016504:Breast Self-Examination; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease / Q000523:psychology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008327:Mammography / Q000523:psychology* / Q000706:statistics & numerical data; D008408:Mastectomy / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation; D016387:Women's Health