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False-positive mammograms lead to greater prescription use for anxiety, depression

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Joel E. Segel

Women who received false-positive mammogram results appeared more likely to initiate medication for anxiety or depression than those who initially received negative results, according to study results.

“These results highlight the need to resolve false-positives quickly and effectively, and to monitor depressive symptoms following a positive result,” Joel E. Segel, PhD, assistant professor of health policy and administration at The Pennsylvania State University, and colleagues wrote.

Segel and colleagues conducted a retrospective cohort study to assess the effect of a false-positive mammogram on the initiation of medication for anxiety or depression. They also aimed to identify subpopulations at highest risk for such medication use.

Researchers used commercial and Medicaid claims databases to pool data on women aged between 40 to 64 years who underwent screening mammography. The women had no prior claims for use of anxiety or depression medications.

Three months after a false-positive mammogram, results revealed relative risks (RR) for initiation of anxiety or depression medication of 1.19 (95% CI, 1.06-1.31) among the commercially insured and 1.13 (95% CI, 0.96-1.29) among the Medicaid population.

The researchers identified four subgroups at particularly commercially insured women aged 40 to 49 years (RR = 1.33; 95% CI, 1.13-1.54), women whose false-positive result required multiple tests to resolve (RR = 1.37; 95% CI, 1.17-1.57), those whose false-positive result included a biopsy (RR = 1.68; 95% CI, 1.18-2.17), and those whose false-positive result took more than 1 week to resolve (RR = 1.21; 95% CI, 1.07-1.34).

HemOnc Today spoke with Segel about the study and the clinical implications of the results.

Question: What prompted this research?

Answer: We were interested in the general issue of false-positive mammograms, particularly in terms of seeing some of the changes in the guidelines. We found that most of the research was focused on self-reported anxiety or depression. We wanted to see if there was any evidence that false-positive mammograms may lead to increases in anxiety treatment.

Q: What did you find?

A: Overall, we found that women who experience a false-positive mammogram had a modest yet significant increase in the likelihood of initiating either an anxiety or depression medication compared with women who initially had a negative mammogram. We also found certain subgroups who may be particularly likely to initiate anxiety or depression medication. Our most consistent result across both Medicaid and commercially insured women was that women whose false-positive required more than one test to resolve showed higher rates of medication initiation. Among the commercially insured, the highest rates of initiation were for women who had a biopsy as part of a false positive. We also found higher initiation rates for women aged 40 to 49 years, which may be the age group where the first false-positive experience occurs.

Q: Did these findings surprise you?

A: We did not know what to expect in terms of increased medication use. We thought we might see a more significant effect in the Medicaid population than the commercially insured. One of the difficulties, given the way we set up the analysis, is that we have to follow women for a fairly long follow-up period — 1 to 2 years. However, people may move in and out of Medicaid coverage, whereas the commercially insured population is more likely to be continually enrolled. So, some of the more modest findings among the Medicaid population may be due to the sample population being less representative of the overall Medicaid population, in which churn is fairly common.

Q: What are the clinical implications of the findings?

A: Our results show that both women for whom the false-positive requires multiple tests or longer to resolve may be more likely to initiate either anxiety or depression medications. It certainly suggests that — to an extent — if the follow-up tests can be done accurately and quickly, it may reduce the anxiety levels surrounding the false positive.

Q: How long does the resolution process typically take?

A : That is a little tricky to say. We found it takes a week on average, but our data are a bit older and this has decreased over time. Some providers have begun to practice same-day reading of the results. My sense is the time has decreased overall, but it often varies depending upon the provider.

Q: Can you offer suggestions for how the process can be accelerated?

A: This is probably an instance of how providing patient-centered care can be beneficial to patients. Discussing the results with patients and making sure they understand both what the results mean and what the next steps are is essential. Then, it is important to make sure follow-up care is scheduled and provided in a timely manner. As with any care that connects specialty and primary care, it is important to be sure to either follow up with the patient or coordinate follow-up with the patient's primary care provider or some other type of resource to make sure the patient is getting the care and support they need.

Q: Are there plans for future research?

A: As the guidelines have changed and this issue has gained prominence, we are looking at more recent data. We also are seeing how changes in screening practices and technology may affect false positives and their effect on anxiety.

Q: Is there anything else that you would like to mention?

A : Screening mammography certainly remains an important part of early breast cancer diagnosis. Adding to what I said about patient-centered care, we should make sure that providers are following-up with patients, given that it can certainly be an anxiety-driven time for them. – by Jennifer Southall

Reference:

Segel JE, et al. Med Care. 2017;doi:10.1097/MLR.0000000000000760.

For more information:

Joel E. Segel, PhD, can be reached at The Pennsylvania State University, 504S Donald H. Ford Building, University Park, PA 16802; email: jes87@psu.edu.

Disclosure: Segel reports no relevant financial disclosures.