Long-term psychosocial consequences of false-positive screening mammography

Abstract

Purpose: Cancer screening programs have the potential of intended beneficial effects, but they also inevitably have unintended harmful effects. In the case of screening mammography, the most frequent harm is a false-positive result. Prior efforts to measure their psychosocial consequences have been limited by short-term follow-up, the use of generic survey instruments, and the lack of a relevant benchmark-women with breast cancer.

Methods: In this cohort study with a 3-year follow-up, we recruited 454 women with abnormal findings in screening mammography over a 1-year period. For each woman with an abnormal finding on a screening mammogram (false and true positives), we recruited another 2 women with normal screening results who were screened the same day at the same clinic. These participants were asked to complete the Consequences of Screening in Breast Cancer-a validated questionnaire encompassing 12 psychosocial outcomes-at baseline, 1, 6, 18, and 36 months.

Results: Six months after final diagnosis, women with false-positive findings reported changes in existential values and inner calmness as great as those reported by women with a diagnosis of breast cancer (Δ = 1.15; P = .015; and Δ = 0.13; P = .423, respectively). Three years after being declared free of cancer, women with false-positive results consistently reported greater negative psychosocial consequences compared with women who had normal findings in all 12 psychosocial outcomes (Δ >0 for 12 of 12 outcomes; P <.01 for 4 of 12 outcomes).

Conclusion: False-positive findings on screening mammography causes long-term psychosocial harm: 3 years after a false-positive finding, women experience psychosocial consequences that range between those experienced by women with a normal mammogram and those with a diagnosis of breast cancer.

Figure 1

The distribution of screening results and final diagnosis among the eligible women and these women’s response rates at 5 time points: baseline, 1, 6, 18, and 36 months.

Figure 2

The mean score of each of the 8 psychosocial outcomes, part I of the COS-BC for the 3 screening groups at 5 time points: 0, 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 2

The mean score of each of the 8 psychosocial outcomes, part I of the COS-BC for the 3 screening groups at 5 time points: 0, 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 2

The mean score of each of the 8 psychosocial outcomes, part I of the COS-BC for the 3 screening groups at 5 time points: 0, 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 2

The mean score of each of the 8 psychosocial outcomes, part I of the COS-BC for the 3 screening groups at 5 time points: 0, 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 2

The mean score of each of the 8 psychosocial outcomes, part I of the COS-BC for the 3 screening groups at 5 time points: 0, 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 2

The mean score of each of the 8 psychosocial outcomes, part I of the COS-BC for the 3 screening groups at 5 time points: 0, 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 2

The mean score of each of the 8 psychosocial outcomes, part I of the COS-BC for the 3 screening groups at 5 time points: 0, 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 2

The mean score of each of the 8 psychosocial outcomes, part I of the COS-BC for the 3 screening groups at 5 time points: 0, 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 3

The mean score of each of the 4 psychosocial outcomes, part II of the COS-BC for 2 or 3 of the screening groups at 4 time points: 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 3

The mean score of each of the 4 psychosocial outcomes, part II of the COS-BC for 2 or 3 of the screening groups at 4 time points: 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 3

The mean score of each of the 4 psychosocial outcomes, part II of the COS-BC for 2 or 3 of the screening groups at 4 time points: 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.

Figure 3

The mean score of each of the 4 psychosocial outcomes, part II of the COS-BC for 2 or 3 of the screening groups at 4 time points: 1, 6, 18, and 36 months. COS-BC = Consequences of Screening in Breast Cancer.