Article Figures & Data
Figures
- Figure 1
Diagram of participation showing the number of women with false-positives and type of management.
Notes: The response rates to the survey at baseline and 1, 6, 18, and 36 months are shown in the boxes. For completeness, the numbers and distribution of women in the original cohort are also provided.
- Figure 2
Psychosocial consequences of abnormal screening mammography over time, measured by part 1 of the Consequences of Screening-Breast Cancer (COS-BC) questionnaire.
Notes: The figure shows the mean score of each of the 6 scales and 2 single items of part 1 of COS-BC (y axis), for the 2 groups of women with false-positive mammography at 5 time points: 0, 1, 6, 18, and 36 months (y axis). The mean scores for women with breast cancer and women with normal mammography are also shown for completeness. Higher scores indicate greater negative psychosocial outcome.
- Figure 3
Long-term psychosocial consequences of false-positive mammography over time, measured by part 2 of the Consequences of Screening-Breast Cancer (COS-BC) questionnaire.
Notes: The figure shows the mean score of each of the 4 scales of part 2 of COS-BC (y axis), for the 2 groups of women with false-positive mammography. The questions about long-term consequences were relevant only after women were informed of their diagnosis; therefore, they were assessed at 4 time points: 1, 6, 18, and 36 months (y axis). The mean scores for women with breast cancer and women with normal mammography are also shown for completeness. Higher scores reflect changes in psychosocial dimensions, regardless of whether this change was positive or negative.
Tables
Characteristic Total (N = 252) Management Group P Value Noninvasive (n = 170) Invasive (n = 82) Age-group, No. (%) 50–54 y 106 (42.1) 75 (44.1) 31 (37.8) .74 55–59 y 62 (24.6) 42 (24.7) 20 (24.4) 60–64 y 43 (17.1) 27 (15.9) 16 (19.5) ≥65 y 41 (16.3) 26(15.3) 15 (18.3) Age, median (IQR), y 56.8 (53.2–62.3) 56.8 (52.8–61.7) 57.0 (53.2–62.6) .41 Living alone, No. (%) No 173 (70.9) 121 (72.9) 52 (66.7) .32 Yes 71 (29.1) 45 (27.1) 26 (33.3) Employment status, No. (%) Working 138 (56.6) 92 (55.4) 46 (59.0) .83 Unemployed 8 (3.3) 6 (11.8) 2 (2.6) Pensioned 98 (40.2) 68 (41.0) 30 (38.5) Social class,a No. (%) I (highest) 5 (2.1) 3 (1.8) 2 (2.6) .64 II 36 (14.8) 26 (15.8) 10 (12.8) III 49 (20.2) 29 (17.6) 20 (25.6) IV 87 (35.8) 60 (36.4) 27 (34.6) V 66 (27.2) 47 (28.5) 19 (24.4) IQR = interquartile range.
- Table 2
Psychosocial Consequences of Women With False-Positive Mammography Managed Invasively vs Noninvasively
Scale (Possible Range) Mean Difference Between Groups (CI)a Baseline 1 Month 6 Months 18 Months 36 Months Dejection (0–18)b −0.14 (−1.95 to 1.67) 0.79 (−0.86 to 2.44) 0.17 (−0.94 to 1.29) 0.68 (−0.80 to 2.16) −0.27 (−1.60 to 1.07) Anxiety (0–18)b −0.27 (−2.09 to 1.55) 0.84 (−0.76 to 2.44) 0.41 (−1.03 to 1.84) 0.44 (−0.77 to 1.65) −0.71 (−2.38 to 0.96) Negative Impact on Behavior (0–21)b −0.20 (−1.75 to 1.35) 0.67 (−0.74 to 2.09) 0.37 (−1.06 to 1.79) 0.39 (−0.99 to 1.78) −0.72 (−2.17 to 0.72) Negative Impact on Sleep (0–12)b − 0.21 (−1.56 to 1.14) 0.75 (−0.41 to 1.90) 0.10 (−0.68 to 0.88) 0.54 (−0.97 to 2.05) −0.62 (−1.94 to 0.71) Breast Examination (0–6)b 0.09 (−0.54 to 0.73) −0.06 (−0.60 to 0.48) 0.06 (−0.59 to 0.71) −0.06 (−0.59 to 0.47) −0.07 (−0.70 to 0.56) Negative Impact on Sexuality (0–6)b 0.49 (−0.49 to 1.47) 0.15 (−0.44 to 0.73) −0.14 (−0.88 to 0.61) 0.02 (−0.37 to 0.42) −0.30 (−1.07 to 0.47) Felt Less Attractive (0–3)b −0.08 (−0.25 to 0.10) 0.02 (−0.13 to 0.17) 0.07 (−0.22 to 0.37) 0.12 (−0.21 to 0.45) 0.05 (−0.14 to 0.24) Keeping Mind Off Things (0–3)b 0.16 (−0.24 to 0.55) 0.15 (−0.19 to 0.48) −0.04 (−0.32 to 0.24) 0.15 (−0.24 to 0.55) −0.10 (−0.37 to 0.17) Worries About Breast Cancer (0–4)b – 0.29 (−0.17 to 0.74) 0.30 (−0.35 to 0.95) 0.06 (−0.43 to 0.56) 0.17 (−0.30 to 0.64) Inner Calm (0–4)b – 0.05 (−0.38 to 0.48) 0.04 (−0.41 to 0.49) 0.23 (−0.26 to 0.72) −0.07 (−0.49 to 0.35) Social Network (0–6)b – 0.31 (−0.14 to 0.76) 0.25 (−0.30 to 0.80) 0.20 (−0.28 to 0.69) 0.22 (−0.23 to 0.67) Existential Values (0–12)b – 0.65 (−0.56 to 1.86) 1.00 (−0.34 to 2.34) 0.33 (−0.98 to 1.64) −0.55 (−1.57 to 0.48) Total sum-score of COS-BC part 1 (0–87)c 2.13 (−5.13 to 9.39) 1.95 (−2.97 to 6.88) 0.08 (−3.12 to 3.29) 0.35 (−2.78 to 3.48) 2.72 (−9.69 to 4.25) COS-BC = Consequences of Screening in Breast Cancer.
Notes: Women put on early recall were excluded from the analysis. All analyses were adjusted for age, social class, employment status, and whether the woman lived alone.
↵a Positive differences indicate that women in the invasive group were more distressed than women in the noninvasive group; negative differences indicate that women in the noninvasive group were more distressed than women in the invasive group.
↵b Significance was defined at P <.01 and 99% CIs are presented.
↵c Significance was defined at P <.05 and 95% CIs are presented.
Supplemental Appendixes & Tables
Supplemental Appendixes and Tables
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The Article in Brief
Diagnostic Invasiveness and Psychosocial Consequences of False-Positive Mammography
Bruno Heleno , and colleagues
Background The psychological consequences of a false-positive mammogram are among the important harms of mammography screening. This study examines whether women with false-positive mammograms whose follow-up involved a biopsy had worse psychosocial consequences than women managed only with additional imaging.
What This Study Found Regardless of the nature of follow-up diagnostic tests, women with false-positive mammograms have worse psychosocial consequences than those of women with normal results and better than those of women with breast cancer. This is in contrast to previous research suggesting that more invasive diagnostic procedures after false-positive mammograms are associated with worse negative psychosocial outcomes. Researchers analyzed data on 454 women with abnormal screening mammography and 908 matched control women with normal results. Among the 252 women in the group with false-positive mammography, psychosocial outcomes were similar for those managed invasively (with a biopsy) and those managed noninvasively (with only additional imaging) during 36 months follow-up. In fact, the best estimate for the difference in psychosocial consequences between women managed invasively and noninvasively was close to zero.
Implications
- These findings suggest that women who require only clinical examination and additional imaging experience the same degree of distress as women who undergo invasive procedures. As a result, the authors conclude that interventions to limit the psychosocial harm of mammography screening should focus on reducing the total number of false-positive tests.
