Anxiety and specific distress in women at intermediate and high risk of breast cancer before and after surveillance by magnetic resonance imaging and mammography versus standard mammography

Abstract

Background: Intensive surveillance in women at intermediate and high breast cancer risk is currently investigated in a French prospective, non-randomized, multicentre study. Two surveillance modalities, standard imaging-mammography ± ultrasound ('Mx')-or standard imaging with magnetic resonance imaging ('MRI'), provided according to the level of breast cancer risk, are compared on psychological distress.

Methods: A total of 1561 women were invited to complete the State-Trait Anxiety Inventory (STAI), Impact of Event Scale (IES) Intrusion and Avoidance subscales and breast cancer-risk perception items at T0 (before examination) and T2 (1 to 3 months later) and the STAI-State anxiety at T1 (just after examination). Multiple regression analyses were performed.

Results: Baseline compliance was high (>91%). Between surveillance modalities, women differed significantly for age, education level, breast cancer-risk objective estimates and subjective perception. Mean STAI-State anxiety scores reflected low to moderate distress in both surveillance modalities. At baseline, MRI was associated with lower STAI-State anxiety (p ≤ 0.001) and Avoidance scores (p = 0.02), but at T1 and T2, no difference between surveillance modalities was observed on psychological outcomes. Abnormal surveillance result was associated with a higher STAI-State anxiety (p ≤ 0.01) and IES-Intrusion (p ≤ 0.01) scores; a personal history of breast cancer and higher risk perception was associated with higher psychological distress at T1 and T2.

Conclusion: Standard breast imaging including MRI does not seem to convey more harmful psychological effects than standard imaging alone. Higher psychological distress observed in the case of history of breast cancer or higher breast cancer-risk perception evidences women with needs for specific support and information.

Keywords: MRI; anxiety; breast cancer risk; cancer‐specific distress; intensive surveillance; perceived risk.