Educational examples 181 5 Target population Women aged 40-50 years with increased familial risk of breast cancer Test • Annual breast MRI • Purpose: screening • Role in testmanagement pathway: replacement of mammography • No radiation exposure and no pain compared to mammography Test result BI-RADS: • 0 (incomplete): inconclusive • 1 (negative), 2 (benign): negative • 3 (probably benign): negative with repeated MRI • 4 (suspicious for malignancy), 5 (highly suggestive of malignancy), 6 (known biopsyproven malignancy): positive Including undesirable consequences (burden, side effects, societal costs) related to the test • Allergic reactions to contrast fluid • Claustrophobia • Accessibility issues • Costs Impact on peopleimportant outcomes • TP: diagnosis breast cancer and treatment increased disease- free survival possible overtreatment treatment side effects • FP: increased anxiety harms of biopsies and other confirmatory tests • TN: correct reassurance • FN: delayed diagnosis of breast cancer decreased disease-free survival Interpretation of test results and subsequent management • Positive: biopsy: - positive biopsy: breast cancer, including treatment - negative biopsy: annual follow-up testing • Negative: Annual follow-up (or more frequently in case of BI-RADS 3) • Inconclusive: Retest Including undesirable consequences (burden, side effects, societal costs) related to management • Side effects, adverse events and complications of breast cancer treatment • Costs (breast cancer treatment and sickness leave) (b).
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