# Acceptance, experience, and feedback for supplemental screening in dense breasts among women participating in the BRAID trial

## TL;DR

This study evaluates how well women accept and experience supplemental breast imaging techniques in a trial aimed at improving screening for dense breasts.

## Contribution

The study provides new insights into patient experiences and acceptance of supplemental imaging modalities in breast cancer screening for dense breasts.

## Key findings

- Most participants rated supplemental imaging as similar to or better than mammography.
- Clear communication and empathetic care reduced anxiety and improved experiences with contrast-enhanced imaging.
- Contrast-enhanced techniques had the highest withdrawal rates due to discomfort or anxiety.

## Abstract

To evaluate patient acceptance and feedback regarding supplemental imaging modalities: automated whole-breast ultrasound (ABUS), contrast-enhanced mammography (CEM), and abbreviated breast MRI (AB-MRI) within the BRAID (Breast Screening: Risk Adaptive Imaging for Density) trial.

An adapted Testing Morbidities Index questionnaire was utilised to capture participant experiences and perceptions (January-April 2024) related to AB-MRI, ABUS and CEM. Likert-scale questions assessed discomfort, anxiety, and overall satisfaction for each imaging modality, while thematic analysis was applied to free-text patient feedback. Additionally, reasons for withdrawal were recorded for each modality.

Among 159 women providing feedback, 57/159 (35.8%) underwent ABUS, 52/159 (32.7%) CEM, and 50/159 (31.5%) AB-MRI. Acceptability of ABUS, CEM and AB-MRI was rated similarly to mammography by 71/159 (64.8%) of these respondents, with 72/159 (45.3%) considering them superior. Mild-to-moderate discomfort due to breast compression was reported for ABUS and CEM, whereas AB-MRI resulted in the least discomfort. Pre-procedural anxiety was observed across all imaging modalities, particularly with contrast-enhanced techniques; however, experiences were generally well-tolerated. Effective communication and pre-test information reduced anxiety levels, with most participants willing to repeat the procedures. 151/984 (15.3%) withdrawals in BRAID were due to adverse patient experiences, with contrast-enhanced techniques accounting for most of these withdrawals (CEM: 69/151, 45.7%; AB-MRI: 66/151, 43.7%; ABUS: 12/151, 7.9%). The main reasons for withdrawal were unhappiness with the allocated imaging arm and discomfort or anxiety during the procedure.

Supplemental imaging modalities are generally well-accepted by patients with benefit throughout gained by clear communication and preparedness.

Feedback from a subgroup of women participating in the BRAID trial shows that supplemental imaging alongside routine screening is well-accepted. Clear communication and empathetic care further improve acceptance, supporting a shift toward personalised breast cancer screening for women with dense breasts.

Understanding women’s imaging experiences is essential for optimising breast screening practices.Acceptability of supplemental imaging was rated similar to or better than mammography by most participants.Clear, empathetic communication reduced anxiety and improved experience with contrast-enhanced imaging.

Understanding women’s imaging experiences is essential for optimising breast screening practices.

Acceptability of supplemental imaging was rated similar to or better than mammography by most participants.

Clear, empathetic communication reduced anxiety and improved experience with contrast-enhanced imaging.