Decision quality and regret with treatment decisions in women with breast cancer: Pre-operative breast MRI and breast density

Breast Cancer Res Treat. 2022 Aug;194(3):607-616. doi: 10.1007/s10549-022-06648-7. Epub 2022 Jun 20.


Purpose: We evaluated self-report of decision quality and regret with breast cancer surgical treatment by pre-operative breast MRI use in women recently diagnosed with breast cancer.

Methods: We conducted a survey with 957 women aged 18 + with stage 0-III breast cancer identified in the Breast Cancer Surveillance Consortium. Participants self-reported receipt of pre-operative breast MRI. Primary outcomes were process measures in the Breast Cancer Surgery Decision Quality Instrument (BCS-DQI) (continuous outcome) and Decision Regret Scale (dichotomized outcome as any/none). Generalized estimating equations with linear and logit link were used to estimate adjusted associations between breast MRI and primary outcomes. All analyses were also stratified by breast density.

Results: Survey participation rate was 27.9% (957/3430). Study population was primarily > 60 years, White, college educated, and diagnosed with early-stage breast cancer. Pre-operative breast MRI was reported in 46% of women. A higher proportion of women who were younger age (< 50 years), commercially insured, and self-detected their breast cancer reported pre-operative breast MRI use. In adjusted analysis, pre-operative breast MRI use compared with no use was associated with a small but statistically significantly higher decision quality scores (69.5 vs 64.7, p-value = 0.043). Decision regret did not significantly differ in women who reported pre-operative breast MRI use compared with no use (54.2% v. 48.7%, respectively, p-value = 0.11). Study results did not vary when stratified by breast density for either primary outcome.

Conclusions and relevance: Breast MRI use in the diagnostic work-up of breast cancer does not negatively alter women's perceptions of surgical treatment decisions in early survivorship.

Clinical trials registration number: NCT03029286.

Keywords: BCSC; Breast MRI; Breast cancer; Decision quality; Mastectomy; Patient-reported outcomes.

MeSH terms

  • Breast Density
  • Breast Neoplasms* / diagnostic imaging
  • Breast Neoplasms* / epidemiology
  • Decision Making
  • Emotions
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Mastectomy

Associated data