title: The attitudes of women with BRCA1 and BRCA2 mutations toward clinical breast examinations and breast self-examinations.
abstract: OBJECTIVE
  In screening studies of women with BRCA mutations, magnetic resonance imaging (MRI) plus mammography has >90% sensitivity for detecting breast cancer, with negligible benefit from the addition of breast self-examination (BSE) or clinical breast examination (CBE). Yet CBE is still frequently recommended, and BSE is encouraged for these women. We sought to determine the attitudes of high-risk women toward CBE and BSE.
  
  
  METHODS
  Between November 2005 and May 2006, 137 women with BRCA mutations participating in a screening study consisting of annual MRI and mammography plus semiannual CBE were asked to complete a mailed Likert-type questionnaire.
  
  
  RESULTS
  Of the 94 (67%) respondents, mean age 47 (range 28-67), 94% strongly agreed or agreed that CBE was an important way to detect breast cancer, and almost all believed it provided an important connection to the healthcare team. Only 10% said it increased anxiety. Of the 71 (77%) who performed BSE at least occasionally, 53 thought that regular BSE gave them a sense of control over their own health. Of the 21(23%) who did not practice BSE at all, only 3 did not believe that BSE was helpful, and it made 9 more worried about breast cancer
  
  
  CONCLUSIONS
  Although CBE adds little to cancer detection rates in women with BRCA mutations screened with MRI, the majority of these women considered CBE to be reassuring and an important means of connecting with the healthcare team. Compliance with BSE was only moderate, but it gave a significant proportion of women a greater sense of control.
authors.affiliation: Division of Medical Oncology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Tirtza N
authors.initials: TN
authors.lastname: Spiegel
authors.forename: Kimberley A
authors.initials: KA
authors.lastname: Hill
authors.forename: Ellen
authors.initials: E
authors.lastname: Warner
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D016504:Breast Self-Examination / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008279:Magnetic Resonance Imaging; D008327:Mammography; D008875:Middle Aged; D009154:Mutation; D010808:Physical Examination / Q000523:psychology*