While mammograms are capable of saving the lives of people from breast cancer, a new study suggests their benefits are not universal. Research published in Cancer Epidemiology, Biomarkers & Prevention indicates that many women who receive false-positive results go on to experience psychosocial problems such as anxiety.
In some cases, the study authors noted that negative effects on self-esteem, behavior and sleeping remained for 12 months after receiving the screening result.
According to study author Anetta Bolejko, from the Department of Medical Imaging and Physiology at Skåne University Hospital in Malmö, Sweden, around a third of women involved in the study experienced psychosocial consequences up to 1 year after their diagnostic workup.
“This is important, because women invited to attend mammographic screening should be informed about the potential benefits and harm of the program,” she says, “and the risk of long-term psychosocial consequences of false-positive screening mammography should be acknowledged.”
Mammography – X-ray imaging of the breast – is one of the most common methods of breast cancer diagnosis. Mammograms make it possible for clinicians to detect tumors that cannot be felt and to check for further evidence of cancer after a lump has been identified.
Unfortunately, mammography is not perfect. Sometimes an abnormal result that suggests cancer is present is later proven to be incorrect. These results are referred to as false-positive results.
Every abnormal result necessitates additional testing to determine whether cancer is present, which means that false-positive results can lead to people undergoing unnecessary procedures, including biopsies. This extra testing can be costly and time-consuming, as well as physically discomforting to patients.
To investigate the psychosocial impact of false-positive results, Dr. Bolejko and her colleagues analyzed the responses of 399 women to the Swedish Consequences of Screening – Breast Cancer (COS-BC) questionnaire.
Each participant was enrolled in the study after being recalled to diagnostic work-up following an abnormal mammogram and their responses were used after breast cancer was not found.
The questionnaire was designed to gauge how the women felt and was initially completed by the women before they were told they were free from cancer. The participants then completed the questionnaire again 6 and 12 months later.
Questionnaires were also completed on the same occasions by 499 age-matched control participants who had negative mammogram results.
The researchers found that large numbers of the participants who received false-positive results experienced negative psychosocial consequences following their mammography but before learning they did not have cancer:
- 88% reported feeling a sense of dejection
- 83% reported anxiety
- 67% reported a negative impact on behavior such as difficulty concentrating
- 53% reported problems with sleeping.
After the first round of questionnaires, those who had received false-positive results were over five times more likely to report negative psychosocial consequences than the control participants.
This increased likelihood persisted even after 6 and 12 months, with the participants who had received false-positive results more than twice as likely to report psychosocial consequences than the control participants.
After further analysis, the researchers found that one of the predictors of negative psychosocial consequences was early recall for testing – something that Dr. Bolejko says they were surprised to discover:
“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. This means that we think that early recall should be applied cautiously because it seems to create confusion and maintain psychosocial distress.”
The researchers state that interviews with recalled women have demonstrated support from health care professionals can lead to comfort and security while counseling can lower the risk of psychosocial distress, underlining the importance of personalized face-to-face communication.
“However, additional studies are needed to identify effective methods for facilitating communication and support for diverse populations participating in mammography screening,” they conclude.
Recently, Medical News Today reported on a study published in JAMA Oncology that suggested surgery and radiotherapy for ductal carcinoma in situ (DCIS) – an early, noninvasive stage of breast cancer – may be unlikely to reduce risk of death from cancer.