Shall patients’ anxiety influence surgical decisions for atypical breast lesions? A substudy of the prospective NOMAT trial

Excerpt

Atypical breast lesions (ABL) identified on image-guided biopsies are associated with both a 10–25% probability of concomitant cancer at surgery and a long-term increased risk of breast cancer. Many such ABL may be considered as part of the “overdiagnosis” of current breast cancer screening strategies. Proposing a systematic surgery, as has long been done, leads to procedures with no cancer associated on definitive specimen in 75 to 90% of women, which can be considered as unnecessary. Current guidelines (from NCCN and [1]) recommend to attempt avoiding surgery of lesions at low risk of upgrading (based on pathological classification or models), with close follow-up. However, some patients may be less tolerant to uncertainty and have a lower acceptance of follow-up strategies. NOMAT (clinicaltrials.gov NCT02523612; French Ethics Committee approval 2015-A00045-44) is a national multicenter prospective trial [2] whose primary objective was to validate a prediction model for upgrade at surgery, among women with atypical breast lesions. A secondary objective was to describe the evolution of state anxiety and identify factors associated with this evolution. …