A high proportion of women who received false-positive results on screening mammography reported experiencing psychosocial consequences, such as anxiety, sense of dejection, and negative effects on behavior and sleeping. These consequences persisted for 12 months in some women. The study findings, which can help health care providers give women objective information on pros and cons of screening, were published in Cancer Epidemiology, Biomarkers & Prevention (2015; doi:10.1158/1055-9965.EPI-15-0060).
Lead author Anetta Bolejko, PhD, in the Department of Medical Imaging and Physiology at Skåne University Hospital in Malmö, Sweden, explained that 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. Experiences of psychosocial distress among women who undergo diagnostic work-up as a result of a suspicious mammogram and in whom no malignancy is found (false-positive screening mammography) are an example of adverse effects of breast cancer screening.
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 determined that breast cancer was not present. 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 6 and 12 months later.
Among women who experienced false-positive screening mammography, 88% reported having a sense of dejection, such as being uneasy, sad, or unable to cope, before learning that the positive, or suspicious, screening mammogram was not breast cancer. Anxiety was reported by 83%, and 67% reported experiencing an effect on behavior, such as difficulty dealing with spare time or work, and 53% experienced difficulty sleeping.
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 mammography. At the first time point, they were more than five times more likely to report psychosocial consequences and at 6 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.
“Our results show that psychosocial consequences of false-positive screening [mammography] are common and can persist over time, with approximately one-third of women experiencing psychosocial consequences up to 1 year after the diagnostic work-up,” said 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.
“We were surprised to find that women who are frequently monitored by additional clinical mammography [early recall] following a false-positive screening [mammography] experienced psychosocial consequences,” she added. “This means that we think that early recall should be applied cautiously because it seems to create confusion and maintain psychosocial distress.”