Study Finds Many Women Experience Long-Term Psychosocial Consequences of False-Positive Screening Mammography
Although mammographic screening leads to reductions in breast cancer mortality, some women experience psychosocial side effects and do not benefit from screening, according to a study by Bolejko et al investigating the prevalence and predictors of the psychosocial consequences of false-positive breast cancer screening. The study found that many women experience consistently higher levels of anxiety and a sense of dejection, as well as behavioral issues and sleep disturbances that can last for 12 months.
Early recall was a major predictor for the prevalence of psychosocial consequences. Dissatisfaction with information at the diagnostic workup, being foreign-born, and lack of social support were also contributing factors to psychosocial distress. The importance of finding cancers through early recall, according to the study, should be balanced with the drawbacks. The study is published in Cancer Epidemiology, Biomarkers & Prevention.
Study Methodology
The researchers used the Swedish Consequences of Screening-Breast Cancer (COS-BC) questionnaire to investigate the psychosocial consequences of false-positive screening mammography among 399 women enrolled in the study immediately following a negative diagnosis (free from breast cancer) after a recall examination. Some of these women also had supplementary diagnostic workup, such as fine/core needle biopsy and follow-up by the surgical breast clinic, and/or were scheduled for early recall.
The women underwent mammographic screening between September 2009 and December 2010 at a facility in southern Sweden. During that time, 47,872 women, ages 40 to 74, were screened, and the average recall rate was 3.1%.
The study participants were asked how they felt before the final diagnosis (considered free from breast cancer) and then at 6 and 12 months later.
Five COS-BC scales, including sense of dejection, anxiety, behavioral, sleep, and existential values, were used as outcome measures.
Study Findings
Women with false-positive mammography had a consistently higher prevalence of all five consequences compared with controls (P < .001). The prevalence decreased between baseline and 6 months (P < .001), but was stable between 6 and 12 months (P ≥ .136). Early recall profoundly predicted long-term consequences for all five outcomes (odds ratio [OR] = 3.05–10.31), along with dissatisfaction with information at recall (OR = 2.28–2.56), being foreign-born (OR = 2.35–3.71), and lack of social support (OR = 1.13–1.25).
Among these women, 88% reported having a sense of dejection, such as feeling uneasy, sad, or unable to cope, before learning that the positive (suspicious) screening mammogram was not breast cancer. Eighty-three percent of the women reported feeling anxious; 67% said they were experiencing an effect on behavior, such as difficulty dealing with spare time or work; and 53% experienced difficulty sleeping.
“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 1 year after the diagnostic workup,” said Anetta Bolejko, PhD, Department of Medical Imaging and Physiology at Skåne University Hospital in Malmö, Sweden, in a statement. “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.”
Dr. Bolejko is the corresponding author of the Cancer Epidemiology, Biomarkers & Prevention article.
Funding for this study was provided by Skåne University Hospital, the National Health Services, and Lund University. The study authors reported no potential conflicts of interest.
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