Women with false-positive mammograms report high anxiety and reduced quality of life

January 13, 2011

Doctors are calling for women to receive more information about the pitfalls of breast cancer screening, as well as the benefits, after some women who received false-positive results faced serious anxiety and reduced quality of life for at least a year.

A study published online by BJS, the British Journal of Surgery, shows that patients with false-positive results - where the mammogram is abnormal but no cancer is present - had to undergo more diagnostic procedures than women with before they were given the all clear.

Researchers from The Netherlands spoke to 385 women with abnormal mammogram results - 152 were subsequently diagnosed with breast cancer, but the other 233 had false-positive results and did not have cancer.

"Common sense tells us that early detection of breast cancer is good and most screening programmes have been successful in reducing breast cancer deaths" says lead author Dr Lideke van der Steeg from the Department of Surgery, St Elisabeth Hospital, Tilburg, and the Centre of Research and Psychology in Somatic Diseases, Tilburg University.

"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 - which is estimated to happen in 60 per cent of abnormal - than if they were actually diagnosed with breast cancer."

Women with abnormal mammograms attending three hospitals over a five-year period 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, level of independence, social relationships, environment and spirituality.

Clinical data were obtained from the women's medical records and they were also asked to complete questionnaires providing demographic information such as age, marital status, education and socioeconomic status.

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

The key factors influencing QoL scores differed between the two groups:

  • Trait anxiety (a tendency to experience anxiety) accounted for up to 55 per cent of the variance in the QoL score in the FP group. It reached this peak at three months, but was similar at months one and 12 (43 per cent and 40 per cent respectively).
  • State anxiety (temporary anxiety due to a specific situation) accounted for up to 46 per cent of the variance in the BC group. It peaked at six months, but was similar in months one and 12 (32 per cent and 34 per cent).
  • State anxiety levels did not significantly influence QoL in the FP group and trait anxiety levels did not influence QoL in the BC group.
Significantly more diagnostic procedures, including biopsies, were needed in the FP group to reach a final diagnosis. Only 14 per cent of the BC group required four procedures - the other 86 per cent required three - while 32 per cent of the FP group required more than three. Fifty-five per cent of the FP group returned to the outpatient clinic in the first year, some as many as eight times.

The authors believe that the anxiety and lower QoL experienced by women in the FP group were soley due to the recall after screening and the subsequent diagnostic procedures.

"The decision to participate in a screening programme 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 chose 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."

More information: The full paper can be accessed free online at: onlinelibrary.wiley.com/doi/10.1002/bjs.7371/pdf

Related Stories

Recommended for you

'Bet hedging' explains the efficacy of many combination cancer therapies

December 14, 2017
The efficacy of many FDA-approved cancer drug combinations is not due to synergistic interactions between drugs, but rather to a form of "bet hedging," according to a new study published by Harvard Medical School researchers ...

Liquid biopsy results differed substantially between two providers

December 14, 2017
Two Johns Hopkins prostate cancer researchers found significant disparities when they submitted identical patient samples to two different commercial liquid biopsy providers. Liquid biopsy is a new and noninvasive alternative ...

Testing the accuracy of FDA-approved and lab-developed cancer genetics tests

December 14, 2017
Cancer molecular testing can drive clinical decision making and help a clinician determine if a patient is a good candidate for a targeted therapeutic drug. Clinical tests for common cancer causing-mutations in the genes ...

Scientists unlock structure of mTOR, a key cancer cell signaling protein

December 14, 2017
Researchers in the Sloan Kettering Institute have solved the structure of an important signaling molecule in cancer cells. They used a new technology called cryo-EM to visualize the structure in three dimensions. The detailed ...

Newest data links inflammation to chemo-brain

December 14, 2017
Inflammation in the blood plays a key role in "chemo-brain," according to a published pilot study that provides evidence for what scientists have long believed.

One in five young colon cancer patients have genetic link

December 13, 2017
As doctors grapple with increasing rates of colorectal cancers in young people, new research from the University of Michigan may offer some insight into how the disease developed and how to prevent further cancers. Researchers ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.