A new decision-making aid, developed by experts at UVA Health and their collaborators, helps women at high risk of breast cancer decide whether to add MRIs to their screening regimen.
The tool has proven popular with patients and doctors in early testing, and is designed to assist women estimated to have a 20 percent or greater of developing breast cancer during their lifetimes. Magnetic resonance imaging (MRI) increases the odds of detecting breast cancer, but also comes with a significant risk of false positives. That can make for a difficult decision for high-risk women, who must balance their desire to catch cancer early with the potential stress and additional testing that follows a false positive.
A small pilot study drew nearly universal praise for the decision-making aid. Twenty-three of 24 participants said they found the tool helpful and that it provided greater peace of mind; one was neutral on its helpfulness. Of 16 participants who were undecided on their screening option before using the decision aid, 13 made a choice during the same clinic visit they used the tool.
Healthcare providers who participated in the study also liked the decision-making aid, and said it was useful, facilitated discussion and was easy to fit into clinic visits.
“This is a complex decision for patients,” Dr. Lynn Dengel, a surgical oncologist at UVA Cancer Center and a developer of the tool, said. “We were excited to see that there is potential for the novel decision aid to improve shared decision-making in establishing a screening plan for patients at high risk of developing breast cancer.”
MRI screening for breast cancer in high-risk women is estimated to detect an additional 15 to 18 cancers per 1,000 women because of its great sensitivity. But the false positive rate is substantial, ranging from 14 to 38 percent during the initial MRI screening and from 8 to 18 percent in subsequent screenings.
The new decision aid consists of three key steps to help patients make their choice. The first is an interactive exercise that uses contrasting statements to identify what the person considers most important; the second lets the patient compare screening options, along with their pros and cons; and the third prompts the user to indicate whether she would prefer to go with mammograms only or mammograms with MRI, of if she remains uncertain.
After using the decision aid, 11 of the 16 initially undecided trial participants elected to undergo MRI screening. Of the participants who had made a choice prior to using the tool, all stayed with their initial decision.
UVA researchers say the promising response to the decision aid warrants further study in larger, multi-site trials, to determine if the tool should be rolled out to high-risk patients broadly. Such tools are already available for women at average risk, researchers note, but this tool, they believe, would be the first for high-risk women.
“We aim to further develop the decision-aid intervention so that patients in the breast-care setting can have guided conversations to decide the best regimen for their needs and preferences,” tool developer Dr. Crystal Chu of the UVA School of Nursing said. “The use of a decision aid can empower patients to make informed, shared decisions while receiving personalized, patient-centered care.”
Dengel and Chu also created a decision aid for patients who have been diagnosed with cancer in one breast and are considering having both the cancerous and healthy breast removed.
Developing new and better ways to diagnose, treat and cure cancer and to improve the patient experience are top priorities for UVA Cancer Center, one of only 54 cancer centers in the country awarded the prestigious “Comprehensive Cancer Center” designation by the National Cancer Institute in recognition of their outstanding research and patient care.
The researchers have published their pilot study results in the Annals of Surgical Oncology. Funding for the work was provided by a UVA Internal Department of Surgery grant.
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Rebecca Barnabi
