False-Positive Screening Mammograms Associated With Short-Term Anxiety but No Reduced Intention to Undergo Subsequent Mammography
The effect of false-positive mammograms on women undergoing screening is being investigated by the U.S. Preventive Services Task Force. In a study reported in JAMA Internal Medicine, Tosteson et al assessed responses to false-positive screening mammograms. According to the authors, their findings indicate that “false-positive mammograms are associated with a measurable, small, and transient effect on personal anxiety.” False-positive mammograms did not result in reduced intention to undergo subsequent mammography.
Study Details
The study was a Digital Mammographic Imaging Screening Trial (DMIST) quality-of-life substudy telephone survey that included randomly selected participants with false-positive and negative mammograms. The survey was performed shortly after screening and 1 year later.
The six-question short form of the Spielberger State-Trait Anxiety Inventory state scale (STAI-6) was used to assess anxiety and the EuroQol EQ-5D instrument with U.S. scoring was used to assess general health-related quality of life. Among 1,450 women invited to participate, 1,226 (84.6%) were enrolled and follow-up interviews were obtained in 1,028 (83.8%). Of these, 534 had negative mammograms and 494 had false-positive mammograms.
Among women with false-positive results, 259 did not know that they did not have breast cancer at the time of the telephone survey (unresolved subgroup), with the remainder knowing that their mammogram was false-positive (resolved subgroup) at the time of the survey.
Anxiety and Health Utility
At baseline, mean STAI anxiety score was significantly higher in the false-positive group (35.2 vs 32.7), but there were no significant differences between groups on the EQ-5D or a health rating score (0 = worst, 100 = best). At 1 year, the total false-positive group had a significant decrease in STAI anxiety score (mean difference = −1.53, P = .01), with no significant change in the resolved subgroup (mean difference = −1.53, P = .17) or unresolved subgroup (mean difference = −1.52, P = .10).
There was no significant change from baseline at 1 year in the STAI anxiety score in the negative group or in EQ-5D score in either group. The negative group had a significantly lower health rating score at 1 year (−1.22, P = .03). The change in health rating in the total false-positive group was not significant (−0.25, P = .69), with a nonsignificant decrease in the initial unresolved subgroup (−1.55, P = .07) and a nonsignificant increase in the initial resolved subgroup (+1.18, P = .07).
Additional Care
With regard to breast-related care during the year after mammography, significantly greater proportions of women with false-positive results (all P < .001) underwent any additional imaging (66.2% vs 4.5%), additional mammography (56.7% vs 3.7%), ultrasound (28.5% vs 1.3%), surgical consultation (7.3% vs 1.1%), and biopsy or needle aspiration (14.6% vs 1.1%). Anxiety related to additional care was rated as moderate by 27.2% vs 11.1%, a lot by 18.8% vs 3.5%, and extreme by 4.6% vs 1.0% (moderate or worse in 51% vs 16%). Discomfort associated with additional care was rated as moderate by 23.0% vs 11.5%, a lot by 7.9% vs 2.8%, and extreme by 4.3% vs 1.0% (moderate or worse in 35% vs 15%).
Attitudes Toward Future Mammography
With regard to attitudes toward future mammography, there were no significant differences between the false-positive group and the negative group with regard to intention to have mammography within the next 2 years (93.5% vs 93.4%), choice of a new mammography type that would produce fewer false-positive results (82.4% vs 80.9%) vs less breast compression, or willingness to travel < 30 minutes (12.8% vs 16.3%), up to 4 hours (70.6% vs 66.5%), up to overnight stay (6.1% vs 5.6%), or overnight (9.9% vs 10.5%) to avoid false-positive mammograms.
There were no differences between groups with regard to level of anticipated anxiety over a future false-positive mammogram. When asked about intention to use future screening (less likely, unchanged, or more likely), more patients in the false-positive group indicted that they were “more likely” to use such screening (25.7% vs 14.2%, P < .001 for trend).
On multivariate analysis, future screening intention was significantly increased among women with false-positive mammograms (odds ratio [OR] = 2.12, 95% confidence interval [CI] =1.54-2.93), younger age (OR = 2.78, 95% CI = 1.55.0), and poorer health (OR = 1.63, 95% CI = 1.092.43). Anticipated high-level anxiety regarding future false-positive mammograms was associated with willingness to travel overnight to avoid false-positive outcome (OR = 1.94, 95% CI =1.28–2.95).
The investigators concluded, “False-positive mammograms were associated with increased short-term anxiety but not long-term anxiety, and there was no measurable health utility decrement. False-positive mammograms increased women’s intention to undergo future breast cancer screening and did not increase their stated willingness to travel to avoid a false-positive result. Our finding of time-limited harm after false-positive screening mammograms is relevant for clinicians who counsel women on mammographic screening and for screening guideline development groups.”
Anna N.A. Tosteson, ScD, of Geisel School of Medicine at Dartmouth, is the corresponding author for the JAMA Internal Medicine article.
The study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit archinte.jamanetwork.com.
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