Episode 58: The Complexity of Breast Density & Breast Cancer Imaging

Dr. Karen Wernli, a Senior Scientific Investigator at Kaiser Permanente Washington Health Research Institute, explores the topic of preoperative breast MRIs in a PCORI funded study. The conversation provides insights into the emotional and practical aspects of living with cancer and the need for improved communication between researchers and patients. They touch on the classification of breast density, the importance of guidelines, and the need for mandatory reporting of breast density and discuss various topics related to breast cancer screening and decision-making. They also explore the concept of decision quality and how it is measured in research studies.

This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features this PCORI study by Karen Wernli, PhD, Diana Miglioretti, PhD, Karla Kerlikowske, MD, Anna Tosteson, ScD & Tracy Onega, PhD.

About our guest

Karen Wernli, PhD, is a Senior Scientific Investigator at Kaiser Permanente Washington Health Research Institute and Professor in the Department of Health System Science at Kaiser Permanente Bernard J. Tyson School of Medicine. She is a cancer epidemiologist and health services researcher whose work focuses on incorporating patient-centered outcomes to improve health care along the cancer care continuum, from prevention to survivorship. Her work spans several types of cancer (including breast and lung), and explores the impact of cancer in special populations (adolescents and young adults with cancer). Her research strives to answer critical questions at the confluence of patients’ needs and clinical priorities.

Watch the video of our episode on YouTube

  • 13 minutes:

    “Breast MRIs have been increasing over the last 20 years. More women are using it for screening, but also more women are using it for diagnostic purposes. 10 years ago, we published this paper that was looking at why women were having breast MRI and sort of the staging and getting prepared for surgery was a high proportion. I don't quite remember, but maybe like 40%. It's my understanding that at that time, 10 years ago, NCCN guidelines were like, you can use this test, but if you're suspecting it's cancer, you should be going for a biopsy. You shouldn't be using this test to further define tumors. But I think that some practitioners have really incorporated it in terms of being able to really understand the tumor better, so that the surgery is better.”

  • 25 minutes:

    “Women who did receive a preoperative breast MRI had higher reports of decision quality compared to women who didn't get a breast MRI and it's, as we say, statistically significantly different. We hypothesize that maybe this is happening because if you get this other test, maybe your doctor's just talking to you a little bit about what's going on with you. Maybe that additional conversation, maybe you understand something better, and it makes you feel better.”

  • 30 minutes:

    “What's interesting in our results is that when we look at the group of women who have non-dense breasts and we look at the group of women who have dense breasts, the results are a little bit different. They're not statistically significantly different. They're a little bit different. When we look at women who have dense breasts and the difference between those who received a breast MRI and those who didn't, their responses on decision quality are pretty similar. When we look at women who have non-dense breasts, the women who had a preoperative MRI, their responses, or their reflection on decision quality is a little bit higher than those who didn't get a breast MRI.”

Research reported in this podcast  was funded through a Patient-Centered Outcomes Research Institute (PCORI) award (PCS-1504-30370). Data collection for this research was additionally supported by the Breast Cancer Surveillance Consortium with funding from the National Cancer Institute (P01CA154292, U54CA163303), the Agency for Health Research and Quality (R01 HS018366-01A1), the UC Davis Clinical and Translational Science Center, the UC Davis Comprehensive Cancer Center, and the Placer County Breast Cancer Foundation. The perspective shared is solely the responsibility of Dr. Wernli and does not necessarily represent the official views of the Patient Centered Outcomes Research Institute or Kaiser Permanente.

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