False-positive mammograms heighten anxiety, willingness for future screening

False-positive mammograms are associated with increased short-term anxiety and an increased patient intention to undergo further breast cancer screening, according to a study published online April 21 by JAMA Internal Medicine.

Although a large proportion of women who undergo routine screening mammography will have a false-positive mammogram, little research has been conducted on the effects of false-positive results on generic measures that enable comparison to a broad range of health outcomes. Lead author Anna N.A. Tosteson, ScD, of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., and colleagues created the Digital Mammographic Imaging Screening Trial (DMIST) quality-of-life substudy telephone survey to measure the effect of false-positive mammograms on quality of life by investigating anxiety, health utility and attitudes toward future screening.

The survey, which was comprised of a six-question short form of the Spielberger State-Trait Anxiety Inventory state scale (STAI-6) and the EuroQol EQ-5D instrument with US scoring, was performed shortly after screening and one year later at 22 DMIST sites. DMIST participants with positive and negative mammograms were randomly selected.

Of the eligible participating women, 1,226 enrolled in the study and follow-up interviews were performed in 1,028 of the women. The researchers discovered that anxiety was significantly higher for women with false-positive mammograms, as evidenced in STAI-6 scores of 35.2 versus 35.7. Health utility scores, however, did not differ and there were no significant differences between groups at the one-year mark.

Future screening intentions differed by group, with 25.7 percent of women with false-positive results willing to undergo future screening versus 14.2 percent in the negative group. Willingness to travel and stay overnight, however, did not differ between the two groups. Future screening intentions significantly increased among women with false-positive mammograms, those of a younger age and poorer health.

“We conclude that false-positive mammograms are associated with measurable, small, and transient effect on personal anxiety and that further research should address opportunities for reducing this anxiety,” wrote Tosteson and colleagues. “Our report on women’s experience of false-positive mammograms may provide useful information for those counseling women on the decision to undergo mammographic screening and for screening guideline development groups.”

In a statement released by the American College of Radiology and the Society of Breast Imaging, the organizations wrote: “Like similar previous studies, Tosteson et al published online April 21, 2014 in the Journal of the American Medical Association (JAMA), proves that patients experience short term anxiety regarding test results and that these feelings rapidly decline over time. The study also shows that there are no measurable effects to women’s health from experiencing a false-positive exam as some have previously claimed.”

They posit the idea that anxiety may be more intensely felt in women with a family history of breast cancer or who have experienced a needle biopsy previously. “This suggests that we should better inform professionals regarding which women may be more in need of assistance following initially inconclusive results," they wrote. “It may also be that patient anxiety declines more rapidly than previously documented as the act of answering follow-up questionnaires used in such studies may prolong (e.g. 'bring back') any anxiety that had been present.”

The medical community should help identify which professionals could be of service to these women in coping with and overcoming their concerns, the statement said.