Patient organisation comments

Advice

Two patient groups (Breast Cancer Now and Lobular Breast Cancer UK) reviewed the draft briefing and completed questionnaires asking for their opinions on contrast-enhanced spectral mammography (CESM) as part of the breast cancer diagnosis process.

Both patient groups agreed that CESM could lead to faster breast cancer diagnosis. One said that this would reduce patient stress and anxiety, and the other thought this may lead to earlier intervention and potentially less invasive surgery. One patient group mentioned that provision of further imaging in breast clinics would improve access to breast care nurses and information and support available to patients. They also noted system benefits, including an overall reduction in length and number of appointments, which may improve accessibility to other diagnostic imaging services. Both patient groups mentioned that younger women and those with dense breasts would be likely to benefit from CESM, with 1 highlighting worse survival rates in those under 45 years, compared with those aged between 45 and 74 years. One patient group also thought there was potential benefit in patients with lobular tumours (for which there is no palpable lump, and can be undetected on standard mammography) and those being monitored for recurrence. However, they raised concerns on whether CESM would be equally effective across all types of breast cancer, in particular those which do not form a solid tumour or exhibit single or branched blood flow which may limit contrast uptake. Both patient groups mentioned the use of contrast agent, with 1 stating that this may cause anxiety in patients, and the other noting pain associated with the injection and potential allergic reactions. Both patient groups felt that other imaging modalities should be available for patients who do not wish to have CESM. Both patient groups mentioned potential barriers to adoption, including cost, with 1 stating that this could lead to varied provision of care across the NHS. Both groups also cited staff training as a potential barrier, and 1 noted that specialist breast clinics currently have significant workforce and resource shortages. Both patient groups felt that more evidence was needed, including comparing CESM with other imaging modalities. One group felt that more evidence would demonstrate the benefit of CESM and reassure patients of its use. The other group felt that without this evidence, confirmatory testing should be immediately available for all positive CESM results, as an unexpected diagnosis could cause distress. Both patient groups highlighted that there may be issues in describing or using CESM in patients with a learning disability, mental health issues (including panic and anxiety disorders) or communication difficulties. Both groups also noted that the accessibility of CESM for patients with physical disabilities should be considered. The benefit of CESM when compared with contrast-enhanced MRI in patients with smaller, non-solid or mixed tumours, or when compared to hormone-derived tracers with positron emission tomography (PET) imaging, in hormone-positive cancers, was unclear.