False-Positive Mammograms Lead to Anxiety and Quality-of-Life Issues

A false-positive result on a mammogram may trigger anxiety and decrease quality of life, and the effects may remain apparent a year later, new data suggest.

In addition, the study by Dutch investigators confirmed that women with a false-positive mammogram require more diagnostic procedures than women with breast cancer before a final diagnosis is established.

Alida van der Steeg, PhD, with the department of surgery at St. Elisabeth Hospital in Tilburg, Netherlands, and colleagues reviewed responses to surveys completed by 385 women who had an abnormal screening mammogram. Of the study cohort, 152 women were diagnosed with breast cancer and 233 had a falsepositive result.

Cancer screening is "intuitively appealing," and it is reasonable to assume that early detection is a desirable goal and risk-free, van der Steeg pointed out. Indeed, the majority of breast cancer screening programs have decreased breast cancer-related deaths.

In the Netherlands, women 50 to 75 years of age are sent a standardized invitation for mammography every 2 years as part of a nationwide screening program; however, the information brochure included with the invitation does not succinctly describe possible drawbacks to mammography, she said. In fact, while the brochure stated that about 60% of women who are recalled will be found to have a benign diagnosis, it makes no mention of the sometimes invasive diagnostic procedures that may be needed to make the correct diagnosis; nor is there any mention of the negative psychological effects of a recall assessment.

One percent of Dutch women who undergo screening mammography are asked to return for repeat assessment, van der Steeg noted.

In the present study, women in the breast group were significantly older than women in the false-positive group and also had larger tumors.

The study found that women in the false-positive group required significantly more diagnostic procedures to obtain a final diagnosis, including biopsies. In fact, only 14% of the breast cancer group needed 4 procedures after their initial screening to reach a final diagnosis, while 32% of the falsepositive group needed 4 or more procedures in order to make a final diagnosis.

Notably, 54.9% of the falsepositive group revisited the outpatient clinic within the first year of their initial screening, some as often as 8 times.

In addition, women in the falsepositive group had a significant reduction in their quality of life, especially if they were prone to anxiety, and the effects lasted for at least a year. Also, women who tended to be anxious fared much worse if they were given a false-positive mammogram result than women who were actually diagnosed with breast cancer.

In the study, quality of life was measured by the World Health Organization (WHO) Quality of Life assessment instrument 100 (WHOQOL-100) and anxiety by the State and Trait Anxiety Inventory (STAI), both of which have been widely validated.

The investigators maintain that the anxiety and decreased quality of life occurring in women in the false-positive group were probably entirely a result of the recall after screening coupled with the subsequent diagnostic procedures.

Based on their results, van der Steeg and associates recommend that women be better informed about the purported benefits of screening mammography, as well as liabilities that may include increased anxiety and decreased quality of life.

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van der Steeg AF, Keyser-Dekker CM, De Vries J, Roukema JA. Effect of abnormal screening mammogram on quality of life. Br J Surg. 2010 Dec 20 [Epub ahead of print] doi:10.1002/bjs.7371.

Published in Oncology & Biotech News. February 2011.