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False-positive mammograms increased short-term anxiety
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Most women who received false-positive mammography results reported at least moderate anxiety, yet they appeared more likely to undergo future breast cancer screening than women who received negative results, according to findings of a telephone survey.
Researchers analyzed data from 1,028 women enrolled in the Digital Mammographic Imaging Screening Trial. Of them, 534 received negative mammogram results and 494 received false-positive results.
All women completed the 6-question short form of the Spielberger State-Trait Anxiety Inventory state sale (STAI-6) and the EuroQol EQ-5D via telephone shortly after their screening and then again after 1 year.
Overall, 50.6% of women who received false-positive mammogram results reported moderate or higher anxiety, and 4.6% reported extreme anxiety.
STAI-6 baseline scores were significantly higher among women who received false-positive results compared with women who received negative results (35.2 vs. 32.7). Researchers observed no significant differences between groups with the EQ-5D.
Researchers observed a significant decrease in anxiety at 1 year among women who received false-positive results (mean STAI-6 difference, –1.53; 95% CI, –2.70 to –0.35). At that time, anxiety scores no longer were significantly different between women with false-positive vs. negative results.
More women who received false-positive results reported intentions to undergo future screenings (25.7% vs. 14.2%), yet similar proportions of both groups were willing to travel and stay overnight for mammograms to avoid false-positive results (9.9% vs. 10.5%).
Women were more likely to express intention to undergo future breast cancer screening if they received false-positive results (OR=2.12; 95% CI, 1.54-2.93), were younger (OR=2.78; 95% CI, 1.5-5.0) or were in poorer health (OR=1.63; 95% CI, 1.09-2.43).
Women were more likely to report a willingness to travel overnight when they anticipated having high levels of anxiety due to future false-positive results (OR=1.94; 95% CI, 1.28-2.95).
“The fact that women’s anticipated anxiety about future false-positive mammograms was a correlate of willingness to travel and stay overnight to avoid such a result, but the actual experience of a false-positive mammogram was not, further highlights opportunities to educate women about screening outcomes,” the researchers wrote. “Our report on women’s experience of false-positive mammograms may provide useful information for those counseling women on the decision to undergo mammographic screening and for screening guidelines development groups.”
Disclosure: One researcher reports grants from Alan Penn & Associates, Konica Minolta, Koning Corp., the National Science Foundation, the US Department of Health and Human Services and Zumatek Inc.; patents to Brookhaven Science Associates, NextRay Inc., the University of North Carolina, Chapel Hill, and the University of Saskatchewan; and co-founder and board member roles with NextRay Inc.
Perspective
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Debasish “Debu” Tripathy, MD
The recent debate on mammography has centered on the benefit in lowering the death rate from breast cancer traded off against the large number of women who need to be screened for each life saved. This is due to limitations in the specificity and sensitivity in mammogram and our inability to discern which diagnosed cancers actually need treatment – surgery as well as radiation and chemotherapy. The mortality from added imaging and biopsies is nearly zero, but the consequences of “unnecessary” surgery and other adjuvant treatments need to be factored into this debate.
One of the additional arguments posited has been the concern that false-positive findings could cause long-term effects on quality of life — particularly anxiety and possibly depression. Results from a large randomized screening trial shows that false-positive mammograms led to increased short-term, but not long-term anxiety. There were some impacts on their perceptions on long-term care, however, and as such, these findings add a piece to the complex puzzle on formulating the most informed policy and recommendations for screening mammography.
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