Brain imaging screening in metastatic breast cancer: patients' and physicians' perspectives

Routine brain imaging screening (BIS) in patients with metastatic breast cancer (BC) without neurological symptoms is currently not recommended, as no survival/quality-of-life improvements have been demonstrated. We aimed to examine physicians and patients' attitudes and perceptions toward BIS.

International cross-sectional online survey for patients and physicians, distributed from May 2023 to February 2024. Patients with BC diagnosis were deemed eligible for patients' survey completion and BC-treating physicians were invited to fill the physicians' questionnaire.

A total of 529 physicians from 50 countries (80 % European) responded, mostly medical oncologists (70 %) working in academic hospitals (53 %). Most physicians request BIS (65 %), mainly when extracranial progression occurs, especially for HER2+ and triple negative BC (TNBC). Among physicians never performing BIS (35 %), 91 % would in case of proved clinical benefit. A total of 545 patients from 14 European countries completed the questionnaire. Median age was 50 years, 86 % had metastatic BC, 51 % hormone receptor-positive (HR+)/HER2-negative, 30 % HER2-positive (HER2+) and 19 % TNBC. BM were diagnosed in 11.5 % patients with metastatic BC. 85 % patients would like to undergo BIS, especially younger ones (p = 0.02) and with HR-disease (p = 0.03), despite the uncertain clinical benefit. Notably, 91 % of patients would like to receive information regarding BM, while only 13 % of physicians routinely address the issue.

These results underline the willingness of patients to know more about the prospects of BM development, in contrast to the lack of routine discussion of this topic by physicians. Further investigation is warranted to demonstrate the clinical utility of routine BIS.