Article Text
Abstract
Background Mammography used for breast screening has poor sensitivity in dense tissue.1 Retrospective studies suggest that Molecular Breast Imaging (MBI), used for supplementary screening in the USA but not the UK, has superior diagnostic accuracy to mammography in women with very dense breast tissue.2 3 Women’s perspectives of MBI are unknown, but are crucial to understanding the feasibility of, and routes to, adoption into the NHS.
Methods Semi-structured, one-to-one interviews with screened and unscreened women, recruited via social media, the NHS Breast Screening Programme (NHSBSP), and breast clinics, were undertaken to explore the acceptability of MBI. Data were analysed thematically within NVivo 12 Pro software.
Results Four themes were generated from nineteen interviews: (1) negative aspects of MBI can be justified (2) equity of access, (3) comfort in familiarity and (4) need for shared decisions relating to risk. Participants were not deterred by negative aspects of MBI, such as radiation dose, forty-minute scan time, hospital-based scan, cannulation, provided there are associated benefits as justification. Some participants were concerned about access issues such as parking if MBI scans were hospital-based, raising issues around equitable access. Participants expressed a feeling of comfort in existing screening processes with which they were familiar, and participants with experience of nuclear medicine tests were less concerned about radiation dose. Finally, participants placed considerable trust in the NHS to evaluate tests, as well as expressing a desire for more information. It was acknowledged that informing women of their breast density may result in increased anxiety, but it was still felt to be important that patients are fully informed of both the risks and harms associated with screening tests. This demonstrates a need for the uncertainty in screening decisions to be more effectively discussed to support effective shared decision making.
Conclusion MBI is an acceptable breast imaging modality for UK women. Women wish to be offered personalised, risk-based screening, with tests that offer favourable risk-benefit ratios. High-quality patient information enabling informed decision-making is essential. Further work is needed to understand how MBI will fit into existing screening pathways. New pathway design, for example, risk stratification, should focus on maintaining familiarity for patients as far as practical. We also need to understand the impact of informing women of their breast density and the associated increased risk of developing breast cancer. What level of risk counselling should be offered to women who have extremely dense breast tissue?
References
Radiology 2002;225:165–75.
Ann Nucl Med 2012;26(10):823–9.
AJR Am J Roentgenol 2015;204(2):241–51.