A woman getting an MRI

An icon of a clipboard to signify scholarship in symptom science.Tool aims to help patients decide whether to undergo MRI screening

A decision-making aid to help women at high risk of breast cancer decide whether to add MRIs to their screening regimen has proven popular with both patients and doctors alike in early testing.

The new tool, developed by experts at UVA Health and their collaborators, including surgical oncologist Lynn Dengel, MD, and School of Nursing post-doctoral fellow Crystal Chu (PhD ’23), is designed to assist women estimated to have a 20% or greater risk of developing breast cancer during their lifetimes. While magnetic resonance imaging (MRI) increases the odds of detecting breast cancer, it 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.

Crystal Chu, UVA School of Nursing

“The use of a decision aid can empower patients to make informed, shared decisions while receiving personalized, patient-centered care.”

Crystal Chu, nurse scientist and a post-doctoral fellow, UVA School of Nursing

Praise for the decision-making aid was nearly universal in a small pilot study. 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.

The healthcare providers who participated in the study also liked the decision-making aid, saying it was useful, facilitated discussion and was easy to fit into clinic visits.

"This is a complex decision for patients," said Dengel, who developed and tested the tool with Chu, "and we were excited to see that there is potential for the novel decision to improve shared decision-making in establishing a screening plan for patients at high risk of developing breast cancer.”  

MRI for Breast Cancer Screening

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% during the initial MRI screening and from 8% to 18% in subsequent screenings.

To help patients make their choice, the new decision aid consists of three key steps. 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.

[VIDEO] No Regrets - a CPM decision tool

The 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. There are already such tools available for women at average risk, the researchers note, but this, 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,” Chu said. “The use of a decision aid can empower patients to make informed, shared decisions while receiving personalized, patient-centered care.”

Dengel and Chu have 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.

Findings Published

The researchers have published their pilot study results in the Annals of Surgical Oncology. The research and decision-aid development team consisted of Chu, Caleigh E. Smith, Janelle Gorski, Mark Smolkin, Hui Zhao, Randy A. Jones, Patricia Hollen and Dengel. 

Funding for the work was provided by a UVA Internal Department of Surgery grant.


Originally published in UVA School of Medicine's Making of Medicine blog.