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High Proportion of Women Experience Anxiety Following False-positive Screening Mammography

Study results can help health care providers give women objective information on pros and cons of screening
8/26/2015

PHILADELPHIA — A high proportion of women who had false-positive screening mammography reported experiencing psychosocial consequences such as anxiety, sense of dejection, and negative effects on behavior and sleeping, and for some women these consequences persisted for 12 months, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.Anetta Bolejko, PhD

False-positive screening mammography is a course of events that follows an abnormal mammogram, which after recall and additional diagnostic work-up—for example, clinical mammography, ultrasound, and biopsy—is considered not to be breast cancer, explained Anetta Bolejko, PhD, in the Department of Medical Imaging and Physiology at Skåne University Hospital in Malmö, Sweden.

Among women who experienced false-positive screening mammography, 88 percent reported having a sense of dejection, such as being uneasy, sad, or unable to cope, before learning that the positive (suspicious) screening mammogram was not breast cancer. Eighty-three percent reported anxiety, 67 percent reported experiencing an effect on behavior, such as difficulty dealing with spare time or work, and 53 percent experienced difficulty sleeping.

“Although mammographic screening leads to breast cancer mortality reduction in the population, some women experience side effects and do not benefit from the screening program,” said Bolejko. “Experiences of psychosocial distress among women who underwent diagnostic work-up following a suspicious mammogram and among which no malignancy was found [women who experienced false-positive screening mammography] are an example of adverse effects of breast cancer screening.

“Our results show that psychosocial consequences of false-positive screening mammograms are common and can persist over time, with approximately one-third of women experiencing psychosocial consequences up to one year after the diagnostic work-up,” added Bolejko. “This is important, because women invited to attend mammographic screening should be informed about the potential benefits and harm of the program, and the risk of long-term psychosocial consequences of false-positive screening mammography should be acknowledged.”

Bolejko and colleagues used the Swedish Consequences of Screening – Breast Cancer (COS-BC) questionnaire to investigate the extent of psychosocial consequences of false-positive screening mammography among 399 women who were enrolled in the study immediately after recall to the diagnostic work-up following an abnormal mammogram, and later being considered that breast cancer was not found. These women responded to the Swedish COS-BC questionnaire upon enrollment, according to how they felt before the final diagnosis (considered free from breast cancer), and then at six and 12 months later.

At all time points, women who had false-positive screening mammography were significantly more likely to report psychosocial consequences compared with women who had a negative (no breast cancer) screening mammogram. At the first time point, they were more than five times more likely to report psychosocial consequences and at six and 12 months later they were more than twice as likely to report psychosocial consequences.

In multivariate analyses, the researchers found that early recall was a predictor for experiencing psychosocial consequences, as were dissatisfaction with information at the diagnostic work-up, being foreign-born, and lack of social support.

“We were surprised to find that women who are frequently monitored by additional clinical mammography [early recall] following a false-positive screening mammogram experienced psychosocial consequences,” said Bolejko. “This means that we think that early recall should be applied cautiously because it seems to create confusion and maintain psychosocial distress.”

Bolejko explained that the limitations of the study include that the researchers investigated the extent of psychosocial consequences and not the relevance of the consequences. She noted that the Swedish COS-BC has its limitation in providing this information. To learn about the relevance of psychosocial consequences of false-positive screening mammography, the perception of the individual woman also needs to be explored. 

The senior author of the study is Sophia Zackrisson, MD, associate professor in the Department of Medical Imaging and Physiology.

This study was funded by the Department of Medical Imaging and Physiology at Skåne University Hospital and through governmental funding of clinical research within the National Health Services, Lund University, in Sweden. Bolejko declares no conflicts of interest.