Study: Mammo false positives take a toll

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Women diagnosed with false-positive screening mammography results report negative psychological impacts for up to one year after the diagnosis, according to a study published in the April issue of British Journal of Surgery, leading the authors to call for breast imaging stakeholders to revise the information they share with women to mention these possible negative psychological effects.

“Cancer screening is intuitively appealing, and common sense dictates that early detection is good and without risk,” wrote A.F.W. van der Steeg, MD, of the department of surgery and Centre of Research on Psychology in Somatic Diseases at Tilburg University in the Netherlands, and colleagues. However, previous studies have suggested an abnormal mammogram is stressful and associated with depressive symptoms and anxiety.

van der Steeg and colleagues designed a prospective, longitudinal study to clarify the possible risks and negative side effects of false-positive mammography findings. The study cohort included 152 women diagnosed with breast cancer and 233 with a false-positive diagnosis between September 2002 and January 2007 at three hospitals in the southern part of the Netherlands.

The researchers employed the World Health Organization Quality of Life assessment instrument 100, the Neuroticism Extraversion Openness Five Factor Inventory and the State and Trait Anxiety Inventory to assess quality of life (QoL) and trait anxiety. Women also completed demographic profiles, and researchers obtained clinical data from medical records.

van der Steeg and colleagues found that women in the false-positive group required significantly more diagnostic procedures to reach a final diagnosis than women in the breast cancer cohort, with 32.2 percent of women in the false-positive group requiring more than three procedures. A repeat mammogram sufficed for a final diagnosis in 28.3 percent of women in the false-positive cohort. However, the remaining women required at least one needle biopsy, and 7.7 percent needed an excision biopsy to obtain a final diagnosis.

The follow-up process in the year after the screening mammogram for the false-positive group was mixed; 45.1 percent did not need or want follow-up, whereas 42.9 percent of women in this group visited the clinic once in the year following diagnosis. The remaining women visited the clinic up to eight times during the year following diagnosis.

Ultimately, 60.5 percent of the false-positive women were diagnosed with benign breast disease, a rate that reflects general trends in the Netherlands.

When the researchers turned to the QoL assessment, they found that “women with a high trait anxiety scored significantly lower on QoL and higher on state anxiety, irrespective of the diagnosis.” Both groups scored high on state anxiety before diagnosis, with scores dropping one month after diagnosis. The absolute decreases fell more for the breast cancer group than for the false-positive group.

Women in the false-positive cohort who demonstrated the personality characteristic trait anxiety reported reduced overall QoL. “[A]nxious women fared worse after a false-positive result, an effect that lasted for at least one year after the screening mammogram,” wrote van der Steeg and colleagues.

The researchers noted the relatively low mammography recall rate in the Netherlands; it hovers in the 1 percent range. “Some authors in the U.S. estimate the risk of a false-positive test to be almost 50 percent for women undergoing 10 tests in 10 years,” shared van der Steeg and colleagues. This rate, noted the authors, is affected by the fear of litigation and the frequency of screening.

The authors pointed out that patient educational materials do not mention the diagnostic procedures required to inform a final diagnosis or the potential negative psychological effects of a false-positive diagnosis.

“Women deserve more balanced information to help them choose whether or not to accept the invitation for a screening mammography,” emphasized the authors, adding that the materials should focus on benefits and potential side-effects, including anxiety.