Acceptability of diagnostic tests for breast cancer

Purpose. To assess the acceptability of new non-invasive breast cancer diagnostic tests intended to triage women in need of biopsy. Methods. Women who had abnormal screening tests and had been recommended to have a biopsy were invited to receive digital mammography, magnetic resonance imaging (MRI), and nuclear medicine evaluation (Tc-99m-sestamibi scanning) before biopsy. Participants completed a questionnaire about satisfaction and acceptability of the procedures. Satisfaction measured women's overall and test-specific satisfaction. Acceptability was measured by self-reported discomfort, embarrassment and women's preference in terms of willingness to pay to avoid a biopsy. Results. Women were satisfied with all of the potential diagnostic triage procedures. Most found the tests more comfortable than a routine mammogram (47, 50, and 66% undergoing MRI, digital mammography, and sestamibi scanning, respectively). Women who provided a response to willingness to pay questions (N=43) were willing to pay an average of $611 to have a test instead of a biopsy, if the test was as accurate as biopsy. The willingness to pay significantly decreased to $308 if the test only had 95% accuracy. Those who had prior benign breast disease were less willing to pay for a test with 95% accuracy than those without this history. Conclusion. Instead of immediate biopsy after an abnormal screening, these results suggest that women would find non-invasive triage tests acceptable, or preferable to biopsy if they were equally accurate or nearly equally accurate as a biopsy. New technologies to diagnose breast cancer should focus on decreasing discomfort as well as increasing test accuracy.