False-Positive Mammograms Increased Women’s Worries

Worrying about mammogram results may lead to stronger desire for more screenings

(RxWiki News) Many women consider mammograms to be unpleasant but necessary tasks. However, the results of mammograms may cause a significant amount of worry.

A new study found that women who were told they needed more tests after an initial mammogram had significantly more anxiety than those with normal results from their mammogram.

When the suspicious results turned out to be nothing of concern (called a false-positive), most women rested easy and showed no signs of anxiety when questioned a year later. But they didn't forget that scare, the new study showed. Women who were told that they needed more testing were more likely to return for screenings than women whose mammograms were deemed normal.

"Ask your doctor about screening tests and the likelihood of false-positives."

This study was led by Anna Tosteson, ScD, of the Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire.

For this study, the researchers used information from 1,226 women from 22 institutions. The women were part of the American College of Radiology Imaging Network Digital Mammography Imaging Screening Trial (DMIST). Of the 1,226 women, 1,028 underwent the follow-up interviews.

Women in the study who were told after their mammography that more tests were needed were matched with women around the same age who were told their mammograms were fine. There were 494 women in the false-positive group and 534 women whose mammograms were normal. Shortly after the baseline mammogram, the women completed a telephone survey, which was repeated at the end of a year.

The women were asked a short six-question survey about their anxiety and another five questions about their general health. They were also asked what other breast tests they had, if they were likely to return for their regular screening and if they were willing to undergo some inconveniences to have a test that was more accurate than the initial test.

The interviews were meant to be conducted before the women who were told they needed more testing found out that everything was fine, but this was not always the case.

The women who were told they needed more tests were significantly more stressed than women who were told their mammograms were fine, the researchers learned. A year after those women had their initial scare and were cleared of any concern, they were no longer stressed. But the women who had false-positives were significantly more likely to say they intended to have future screenings than women whose mammograms were normal.

Women who rated their health as poor were also more likely to want future screenings.

The study also found that more than 80 percent of all the women would choose an uncomfortable mammogram if it resulted in fewer false-positives, and more than 65 percent were even willing to travel for as long as four hours to have such a test.

In an editorial about this study, Kurt Kroenke, MD, of the Center for Health Information and Communication in Indianapolis, Indiana, noted that more than 50 percent of the women who reported at least moderate anxiety were those who had false-positives, compared with only 15.7 percent of women whose mammograms were normal.

The women who had false-positives were more likely to say they felt discomfort associated with additional care they received after the first mammogram.

Dr. Kroenke noted that women who have annual screening have a 61.3 percent chance of having one false-positive within 10 years.

"Improved communication with patients about the risks and benefits of a screening test and shared decision making are important steps, but they are not currently feasible in the 10 to 20 minutes allotted for primary care visits,” Dr. Kroenke wrote. Women need to be made aware of the possibility that a test can suggest more testing is needed when they do not have cancer, he noted.

He also suggested that exams in women younger than 50 years should be carefully considered, and that mammograms in women 50 and older every second year rather than annually could cut down on false-positives without increasing poor outcomes. He also noted that radiologists who have access to a woman’s previous mammograms can decrease the likelihood of false-positives by 50 percent.

Dr. Kroenke advocated for more specific screening tests for women.

The American College of Radiology and Society of Breast Imaging also issued a statement. They acknowledged that inconclusive results after an initial mammogram may cause anxiety, particularly among women with a history of breast cancer or those who have had to undergo biopsies in the past. However, “the proven benefits of breast cancer screening far outweigh any harm. According to National Cancer Institute data, since mammography screening became widespread in the mid-1980s, the U.S. breast cancer death rate, unchanged for the previous 50 years, has dropped more than 30 percent,” they wrote.

This study appeared online April 21 in the Journal of the American Medical Association (JAMA).

One of the study’s authors, Etta Pisano, MD, reported some potential conflicts of interest. The other authors disclosed none.

Review Date: 
April 21, 2014