Most women want a biopsy if there is any chance of breast cancer

Two out of three women want a biopsy performed if a radiologist determines there is any chance of breast cancer, according to a study published in the Journal of the American College of Radiology. The authors also found that women overestimate the risk of breast cancer when follow-up imaging or biopsy is recommended for low-risk mammographic abnormalities.

“To effectively engage in shared decision making, physicians must understand patient perceptions of the risks and benefits of screening,” wrote lead author Lars J. Grimm, MD, MHS, department of radiology at Duke University Medical Center in Durham, North Carolina, and colleagues. “To date, research on patient perceptions of breast cancer risk has focused on recurrence and familial risk. Furthermore, women eligible for screening mammography have limited knowledge on the concepts of overdiagnosis and overtreatment. Thus, there is a compelling need to understand patient perceptions of mammography screening outcomes and recommendations.”

Grimm et al. surveyed more than 2,500 patients from five medical centers. Overall, patients estimated that the breast cancer risk for BI-RADS 3 findings was more than 32 percent, though the actual rate is 0 to 2 percent. Patients estimated that the breast cancer risk of BI-RADS 4A findings was more than 41 percent, though the actual rate is 2 to 10 percent.

“Humans generally struggle to accurately estimate risk, especially for low-probability but high-impact scenarios, such as being diagnosed with breast cancer, in which they are likely to make overestimates,” the authors wrote. “Lack of education, such as the frequency of benign breast lesions, can notably influence risk analysis.”

In addition, more than 55 percent of patients reported they would not want imaging follow-up for a low-risk mammographic abnormality. More than 14 percent of patients said they would be comfortable with follow-up imaging over a biopsy if the abnormality had a cancer rate of 2 percent or less.

When asked, “At what chance of cancer would you want a biopsy to be done?” more than 66 percent of patients said they would want a biopsy if there was any chance of breast cancer at all.

“Our study suggests that the majority of women who present for screening mammography would be willing to accept the risk of a false-positive biopsy, even given a lesion with a very low likelihood of cancer based on imaging,” the authors wrote.