Psychological impact of recall on women with BRCA mutations undergoing MRI surveillance

Spiegel, Tirtza N.; Esplen, Mary Jane; Hill, Kimberley A.; Wong, Jiahui; Causer, Petrina A.; Warner, Ellen

doi:10.1016/j.breast.2011.04.004

« Previous Next »The Breast
Volume 20, Issue 5 , Pages 424-430, October 2011

Psychological impact of recall on women with BRCA mutations undergoing MRI surveillance

Tirtza N. Spiegel
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
Mary Jane Esplen
- Department of Behavioral Sciences and Health, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
- De Souza Institute, University of Toronto, 700 University Ave., Toronto, ON M5G 1Z5, Canada
Kimberley A. Hill
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
Jiahui Wong
- De Souza Institute, University of Toronto, 700 University Ave., Toronto, ON M5G 1Z5, Canada
Petrina A. Causer
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
Ellen Warner
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
- Corresponding author. Tel.: +1 416 480 4617; fax: +1 416 480 6002.

Received 22 August 2010; received in revised form 3 March 2011; accepted 10 April 2011. published online 26 May 2011.

Abstract

Objective

The addition of magnetic resonance imaging (MRI) to mammography for surveillance of women with BRCA mutations significantly increases sensitivity but lowers specificity. This study aimed to examine whether MRI surveillance, and particularly recall, is associated with increased anxiety, depression, or breast cancer worry/distress.

Methods

Women with BRCA mutations in an MRI surveillance study were invited to complete: Hospital Anxiety and Depression Scale (HADS), Lerman’s Breast Cancer Worry Scale, Breast Cancer Worry Interference Scale, and a quality of life rating at 3 time points: 1–2 weeks before (T1), 4–6 weeks after (T2) and 6 months after their annual surveillance (T3). Repeated measures analyses were performed over the 3 time points for recalled and non-recalled women.

Results

55 women (30 BRCA1, 25 BRCA2) completed study instruments at T1 and T2, and 48 at T3. Eighteen women (32%) were recalled for additional imaging. At T1, 27 women (49%) were above HADS threshold for “possible cases” for anxiety (score ≥8). Recalled (but not non-recalled) women had a significant increase of HADS anxiety at T2 which dropped to below baseline by T3. No group differences were observed in terms of change over time in other quantitative psychological measures.

Conclusions

While breast MRI surveillance did not have a detrimental psychological impact on women with a BRCA1 or BRCA2 mutation, recalling these very high-risk women for further imaging after a false positive MRI scan temporarily increased their global anxiety.

Keywords: BRCA, Anxiety, MRI screening