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Intensive radiologic surveillance: a focus on the psychological issues
1Sunnybrook & Women's College Health Sciences Centre, University of Toronto, Toronto, Canada. ellen.warner@sw.on.ca
Summary
Women with BRCA mutations often choose surveillance over mastectomy. Intensive surveillance including MRI and ultrasound improves breast cancer detection sensitivity without increasing anxiety or depression.
Area of Science:
- Oncology
- Genetics
- Radiology
Background:
- Women with BRCA1/2 mutations face an 85% lifetime breast cancer risk.
- Most high-risk women opt for surveillance instead of prophylactic mastectomy.
- The impact of surveillance on breast cancer mortality in this group remains unclear.
Purpose of the Study:
- To compare the sensitivity and specificity of breast cancer screening methods in high-risk women.
- To evaluate the psychological impact of intensive surveillance on women with BRCA mutations.
Main Methods:
- Longitudinal study comparing breast MRI, ultrasound, mammography, and clinical breast examination (CBE) since 1997.
- Psychological assessment using Hospital Anxiety and Depression Scale and Breast Cancer Worry Scale in 25 participants over 2 years.
Main Results:
- Breast cancer incidence higher than predicted in this high-risk population.
- Adding MRI and ultrasound to mammography and CBE improves detection sensitivity but reduces specificity.
- Intensive surveillance, including false positives, did not significantly impact anxiety, depression, or breast cancer worry.
Conclusions:
- Intensive surveillance combining advanced imaging with conventional methods enhances breast cancer detection sensitivity in BRCA mutation carriers.
- Current evidence suggests intensive surveillance does not negatively affect psychological well-being in high-risk women.