Published: Mar 22, 2013
By Charles Bankhead , Staff Writer, MedPage Today

Full story:  http://www.medpagetoday.com/PrimaryCare/PreventiveCare/38027

Psychological after-effects of false-positive mammograms persisted for at least 3 years after women received the erroneous findings, investigators reported.

And at 6 months, psychological testing showed that women who received false-positive results remained as upset as women who had breast cancer.

Three years after the false mammography results, women still exhibited greater psychosocial consequences compared with women who had normal mammograms, John Brodersen, MD, PhD, and Volkert Dirk Siersma, PhD, of the University of Copenhagen in Denmark, wrote in an article published online in Annals of Family Medicine.

“Having a false positive is not harmless and causes undesirable outcomes in the long run,” they said.

“The pattern of the 12 psychosocial outcomes in this prospective longitudinal study was consistent. At the time of screen and at 1, 6, and 18 months after screening and final diagnosis, there were, in general, significant differences between the three screening groups: normal, false-positive, and true-positive,” they wrote.

The reported frequency of false-positive mammography results ranges from 20% to 60% in the U.S. and Europe. Several studies have examined the psychological impact of false positives and shown short-term negative effects.

In contrast, studies of the long-term psychological effects of false-positive mammograms have yielded inconsistent results, some showing negative after-effects for as long as 3 years and others showing a diminution of the effects over time, the authors noted in their introduction.

One potential explanation for the inconsistency of previous studies centers on the inadequacy of the measures used to assess psychological effects.

“Focus-group interviews with women with false positives have revealed that the women’s experiences during the critical period from being told the initial abnormal finding to the final false-positive diagnosis are different from their experiences after the final diagnosis,” Brodersen and Siersma continued.

So, they suggested, assessments of the long-term psychological impact must be done in two parts: “A first part that is completed at all the survey assessment points from the critical period encompassing the psychosocial consequences that are associated with the direct threat of breast cancer and a second part that encompasses the long-term psychological changes experienced after the final diagnostic result.”

The authors employed the two-part strategy to evaluate the long-term psychosocial effects of false-positive mammography results among participants in Denmark’s national breast cancer screening program. The study included 454 women ages 50 to 69 who had abnormal mammography results and 864 participants who had normal mammograms.

Participants completed the first part of the Consequences of Screening in Breast Cancer (COS-BC) questionnaire before they had additional workup and evaluation of the abnormal findings. The women completed the second part of COS-BC at 1, 6, 18, and 36 months after final diagnosis (true or false positive).

The first COS-BC survey addresses eight types of psychosocial outcomes, such as self-image, anxiety, sexuality, dejection, and negative effects on behavior. The second component encompasses four scales: perceived changes resulting from the mammography, impact on social relationships, feeling less or more relaxed/calm, and anxiety.

Examination of the 12 psychosocial outcomes encompassed by the two parts of COS-BC showed that mean scores followed similar patterns during the period after learning the initial mammography result to the final diagnosis, regardless of diagnostic outcome (normal, false-positive, or true-positive).

Across all eight components of COS-BC part one, women with abnormal initial results showed significantly greater psychosocial consequences at baseline than women who had normal mammograms (P<0.001).

At 1 month, women with normal mammograms had significantly lower scores on the 12 components of parts one and two of the COS-BC compared with women who had false-positive results and compared with women who learned they had breast cancer (P<0.001). The false-positive group had lower scores compared with the breast cancer group (P<0.001).

At the 6-, 18-, and 36-month follow-up assessments, women with normal mammograms had significantly lower psychosocial impact scores on most outcomes than the false-positive group, which, in turn, had significantly lower scores on most outcomes than the breast cancer group.

“The differences between these three groups diminished at the 36-month assessment, although with the same pattern at the 1-, 6-, and 18-month assessments,” the authors pointed out in their discussion.

“The consistent pattern in the 12 psychosocial outcomes indicated that the negative psychosocial consequences assessed with part one of the COS-BC and the long-term consequences assessed with part two measure the same overall construct: psychosocial consequences of breast screening,” Brodersen and colleagues concluded.