In the United States, 5% to 11% of all screening mammograms result in a recommendation for follow-up to eliminate the possibility of breast cancer, and of those recommended for follow-up, 95% will turn out to be false-positives (abnormal mammograms that do not result in a breast cancer diagnosis within 1 year). Women who are told they have an abnormal mammogram and need a follow-up evaluation often experience anxiety and distress, even when further evaluation does not find breast cancer.
To study ways to help decrease the anxiety and stress associated with abnormal mammograms, Mary B. Barton, M.D., of Harvard Medical School and Harvard Pilgrim Health Care, Boston, and colleagues evaluated the psychological status of women undergoing screening mammograms who received one of two interventions, both interventions, or no intervention. One intervention consisted of providing women with a video and a pamphlet during their office visit that explained breast cancer risk, the reasons for abnormal mammograms, and coping strategies for dealing with the results. The second intervention involved the immediate reading of the mammograms by a radiologist so that any follow-up tests needed (except for a biopsy) could be conducted immediately in the same office visit.
There were 6801 (80%) women who had normal mammograms and 1742 (20%) women who had abnormal mammograms that were later classified as false-positives. (Women who were diagnosed with breast cancer as a result of their screening mammogram were excluded from the study.) Three weeks after their mammograms, 50% of women who had a false-positive reading reported having symptoms of anxiety about the mammogram, compared with 28% of women with normal mammograms. Overall, 3 months after their mammograms, women who had false-positive mammograms still had an elevated level of anxiety.
Three weeks after their mammogram, women with false-positive readings who received the results of their mammogram immediately reported less anxiety than women who had to wait several days to receive their results. Furthermore, more than half of these women reported that their mammogram had been normal, which suggests, the authors say, that the immediate completion of follow-up may have minimized the effect of a false-positive reading to the extent that they never perceived their mammogram as being abnormal.
In contrast, women with false-positive results who were given the educational intervention did not report less stress or anxiety than women who did not receive the educational materials. "Our finding that the radiology intervention was associated with less anxiety than the educational intervention indicates that rapid evaluation of mammographic abnormalities may be a more effective approach to decreasing women's anxieties than trying to change emotional reactions to an abnormal mammogram," the authors write.
Contact: John Lacey, Harvard Medical School, 617-432-0441, John_Lacey@hms.harvard.edu
Citation:
Barton MB, Morley DS, Moore S, Allen JD, Kleinman KP, Emmons KM, Fletcher SW. Decreasing women's anxieties after abnormal mammograms: a controlled trial. J Natl Cancer Inst 2004;96:529–38.
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Journal
JNCI Journal of the National Cancer Institute