Clinically Meaningful Breast MRI Testing Burden Linked With Cancer Worry in Ductal Carcinoma in Situ

Investigators stated that comprehending the quality of life reduction associated with MRI with or without mammography for patients with ductal carcinoma in situ may help to improve patient experience and help in the development of targeted strategies.

Patients with ductal carcinoma in situ who received clinically meaningful breast MRI as part of pretreatment had an association with cancer worry, with investigators emphasizing the need to grasp the quality of life reduction associated with the procedure, according to a cohort study published in JAMA Network Open.

The mean MRI Testing Morbidities Index (TMI) score was 85.9 (95% CI, 84.6-87.3). Of the patients included in the study (n = 244), 58% experienced fear or anxiety before the examination, and 49% experienced fear and 64% experienced pain or discomfort during the examination. Higher levels of cancer worry were associated with greater test-related burden (Regression coefficient, –2.75; SE, 0.94; P = .004).

A total of 355 patients met the eligibility criteria and underwent an MRI. In the substudy, 244 patients were included and completed both timepoint 0 and 1 questionnaires. The median age was 59 years and 44% of patients were insured by Medicaid or uninsured. In terms of race and ethnicity, the smallest population was Black or African American (57%) or another race (55%) vs White (73%) and Hispanic (43%) compared with non-Hispanic or unknown (70%). The time from the preregistration diagnostic mammogram to the TMI assessment was 28 days from breast MRI and 20.5 days to TMI assessment was.

Post-examination, 86% of patients reported no residual mental discomfort, and 87% reported no physical discomfort. The TIMI score before the examination was 82.0 (95% CI, 79.9-84.0; P <.001), and during the examination, the score was 82.7 (95% CI, 80.9-84.4; P <.001). Notably, scores were significantly lower than the post-examination component score (94.8; 95% CI, 93.3-96.3).

The univariable analysis showed that summated MRI TMI scores were significantly associated with decreased cancer worry (regression coefficient –2.79; SE, 0.82; P <.001), higher physical T scores (regression coefficient, 0.20; SE, 0.09; P = .03), mental T scores (regression coefficient, 0.32; SE, 0.10; P = .002), and older age (regression coefficient, 0.13; SE, 0.07; P = .049).

The multivariable analysis adjusted for potential confounders showed an association between cancer worry and breast MRI TMI (regression coefficient, −2.75; SE, 0.94; P = .004). Patients who were Black or African American had a significantly worse MRI burden than those who were White (regression coefficient, −4.18; SE, 2.10; P = .048), but this difference did not hold up in the sensitivity analysis.

Prior to breast MRI, the mean TMI score was 90.0 (95% CI, 88.9-91.0), and the additive method for estimating the joint utility, which used diagnostic mammography then breast MRI after the DCIS diagnosis showed a mean joint utility score of 75.9 (95% CI, 73.9-77.9) with a 15.7% increase in testing burden vs mammography alone.

The univariable analysis joint utility score was associated with decreased cancer worry (regression coefficient, −6.6; SE, 1.2; P < .001), better physical T scores (regression coefficient, 0.37; SE, 0.13; P = .006) mental T scores (regression coefficient, 0.52; SE, 0.15; P < .001), and older age (regression coefficient, 0.22; SE, 0.10; P = .03). In the multivariable analysis, cancer worry was the only facor associated with the joint utility score (regression coefficient, −6.77; SE, 1.31; P <.001). The association continued in the sensitivity analyses using multiple imputations to adjust for missing covariate data (regression coefficient, −6.77; SE, 1.31; P <.001), however, to estimate for the cumulative testing burden, cancer worry was significantly associated with joint utility score.


Fazeli S, Snyder BS, Gareen IF, et al. Patient-reported testing burden of breast magnetic resonance imaging among women with ductal carcinoma in situ: an ancillary study of the ECOG-ACRIN Cancer Research Group (E4112). JAMA Netw Open. 2021;4(11):e2129697. Published November 1, 2021. doi:10.1001/jamanetworkopen.2021.29697. Published correction appears in JAMA Netw Open. 2021 Dec 1;4(12):e2141485