Lots of people get butterflies before a big test. But when it comes to testing associated with a cancer diagnosis, those butterflies can have a notable impact on health-related quality of life (HRQOL).

Diagnostic testing can generate anxiety and fear in patients that is unrelated to the underlying diagnosis or treatment. In a recent study published in JAMA Network Open, researchers assessed the impact of breast MRI on the patient-reported quality of life among women with ductal carcinoma in situ (DCIS).

A team of researchers conducted a cohort study that was a substudy of a nonrandomized clinical trial conducted at 75 institutions in the United States between March 2015 and April 2016. Of the 355 women who met the eligibility criteria, 244 completed the questionnaires and were included in the analysis.

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As the researchers noted, “Breast MRI has emerged as a more sensitive modality for detecting ductal carcinoma in situ (DCIS) compared with mammography, offering the potential to better inform surgical planning. However, testing-related HRQOL reduction represents a risk associated with breast MRI used for DCIS detection and characterization.”

For this study, a 7-question instrument known as the Testing Morbidities Index (TMI) was employed to gauge how patients with DCIS responded before, during, and after undergoing a breast MRI.

Their findings demonstrated that breast MRI created a “clinically meaningful burden,” affecting many patients before and during the test. Specifically, 58% of the women reported experiencing some anxiety and fear prior to breast MRI and 49% had the same type of feelings during the test itself. Some pain or discomfort prior to the test also was reported by 32% of participants, and 64% reported some pain or discomfort during the test; whereas, 86% reported “no residual mental discomfort” and 87% reported “no physical discomfort” after the test.

The study was limited by the participant group being largely composed of White women. Future research is needed to learn more about racial and ethnic disparities in testing burden. The results also may not be generalizable to women without cancer or women with invasive breast cancer as participation was limited to women with recently diagnosed DCIS. Lastly, the responses detailed in the patient-reported outcome evaluations could be affected by recall bias.

The information gleaned from this study can help clinicians improve the experience for their patients with DCIS.

“Knowledge of domain-level outcomes can help with identification and implementation of appropriate targeted interventions to improve the test-related experience,” the researchers wrote. “Women undergoing breast MRI after diagnostic mammography for DCIS may benefit from preprocedural education and counseling to reduce anticipatory stress and improve overall testing experience.”

Disclosure: Some authors declared an affiliation with a biotech, pharmaceutical, and/or device company. Please see the original reference for a full list of authors’ disclosures.


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. doi:10.1001/jamanetworkopen.2021.29697