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False positive mammograms lead to anxiety, lower quality of life

01/16/2011 16:33:00 admin

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Women with false-positive mammogram results are more likely than those receiving a true positive diagnosis of breast cancer to experience anxiety and lower the quality of life, according to a study published online by the British Journal of Surgery.

Researchers from the Netherlands found among 385 women with abnormal mammogram results, 152 were subsequently diagnosed with breast cancer and the other 233 had false-positive results, not cancer.

"Common sense tells us that early detection of breast cancer is good and most screening programs have been successful in reducing breast cancer deaths" says lead author Dr Lideke van der Steeg. "However, while some women truly benefit from early detection, others experience harm and unnecessary anxiety. The women who received false-positives in our study experienced a significant reduction in their quality of life, especially if they were prone to anxiety, and the effects of this lasted at least a year. In fact, women who had a tendency to be anxious fared much worse if they received a false-positive. It is estimated to happen in 60 percent of abnormal mammograms - than if they were actually diagnosed with breast cancer."

Women with abnormal mammograms attending three hospitals for more than five years were invited to participate. Their quality of life (QoL) was assessed using the World Health Organization's Quality of Life instrument 100, which assesses QoL in six domains – physical health, psychological health, levels of independence, social relationships, environment and spirituality.

Clinical data was collected from the participants’ medical records and they were also asked to answer the questionnaires such marital status, education, socioeconomic status and age.

Women in the breast cancer group were significantly older than the women in the false-positive group – 60.2 years versus 57.3 years. They also had larger tumors than the false-positive group – 17.4mm versus 9.9mm.

The major factors impacting QoL scores differed between the two groups:

In the false-positive group, trait anxiety (a tendency to experience anxiety) accounted for up to 55 per cent of the variance in the QoL score. It peaked at three months, but was similar in months one and 12 (43 percent and 40 percent respectively)

In the breast cancer group, state anxiety (temporary anxiety due to a specific situation) accounted for up to 46 percent of the variance in the BC group. It peaked at six months, but was similar in months one and 12 (32 percent and 34 percent).

State anxiety did not have significant influence to QoL in the false-positive group and trait anxiety did not impact the QoL scores in the breast cancer group.

To reach a final diagnosis, more diagnostic procedures were needed in the false-positive group.

However, only 14 percent of the breast cancer group required four procedures-the other 86 per cent need three-while 32 percent of false-positive group required more than three. Fifty-five percent of the false-positive group went back to the hospital in the first year.

The recall after screening and the subsequent diagnostic procedures may lead women with false-positive result to suffer from anxiety and decrease of life quality, the authors said.

Early studies found mammogram screening is not as effective as thought and the procedure by itself increases risk of breast cancer.

"The decision to participate in a screening program requires balanced information about the potential benefits and dangers" says Dr van der Steeg.

"Women often overestimate their risk of breast cancer and the material provided by healthcare professionals and government agencies often focus on the positive aspects of screening and are not always objective.Women deserve more balanced information to help them to choose whether or not to accept a breast screening invitation. This should not only cover the supposed benefits, but explain the potential side-effects of a false-positive, such as the increased feelings of anxiety and reduced QoL found by our study."

Stephen Lau and editing by Aimee Keenan-Greene