Breast Screening: Adverse Psychological Consequences One Month after Placing Women on Early Recall Because of a Diagnostic Uncertainty. A Multicentre Study

Abstract

Background-It was the original intention of the UK National Health Service Breast Screening Programme (NHSBSP) to place women who were not diagnosed with cancer on three yearly routine recall (RR). In 1994-5 approximately 16500 women, aged 50 to 64, were placed on early recall (ER) at a shorter time interval, of which about 98% will have a normal result. This large number exceeds the expectations of the NHSBSP. Objective-To establish the adverse psychological consequences (PCs) for women one month after placement on ER because of a diagnostic uncertainty, and if detected, to suggest practical solutions to reduce them. Methods-Thirteen breast screening centres throughout the UK participated in the study. From March to October 1995 all women who were placed on ER because of a diagnostic uncertainty were identified and compared with groups of women placed on RR (after mammography, assessment, fine needle aspiration, and a benign biopsy). These women were invited to complete a postal questionnaire one month after they were placed on ER or RR. One reminder was sent. Results-Overall 75% of women completed the questionnaire. The adverse PCs of placing women on ER because of a diagnostic uncertainty were higher (63%; n=81 of 130) than those of women placed on RR after mammography (29%; n=38 of 130) (P<0.00001) or assessment (50%; n=64 of 128)(P<0.05), but lower than the adverse PCs of women who underwent a benign biopsy (87%; n=26 of 30)(P<0.05). Factors that were significantly associated with subsequent adverse PCs were identified. Conclusions-The adverse PCs of being placed on ER because of a diagnostic uncertainty were significantly higher than those of women who turned out to have a false-positive mammographic result after assessment. Possible practical solutions are discussed.

Systematic review of the psychological consequences of false-positive screening mammograms

“…Four of the studies were prospective cohorts, 59,[101][102][103][104][105][106] one of these studies 107 included a nested interview study but this was only published as a conference poster, four were retrospective cohorts, 55,61,108,109 two had a cross-sectional design, [110][111][112][113] one of these studies 114 produced national guidelines that contained research findings and one was a RCT 115 of an intervention to improve reattendance.…”

“…The papers follow the same cohort of women over this time but the methods used appear to vary at different time points and it is not always clear on what basis the women included in the study have been selected or how the main outcome measure, the PCQ, has been used. The study includes women with normal mammograms as the control group and compares them with women with false-positive outcomes according to the process used in Orton 1991 n = 1592 109 Ong 1998 guidelines 114 Ong 1997(b) n = 1493 110 Austoker 1994 n = 1493 112 Ong 1996 n = 84 111 Brain 2008 n = 1321 102 Ellman 1989 n = 752 105 Bull 1991 n = 750 106 Ong 1997(a) n = 877 104 Brett 1998 n = 284 103 Brett 2001 n = 505 59 Clements 2008 n = 58 107 Tyndel 2007 n = 2250 101 Smith 1991 n = 103 104 (n = 877), reported primarily on the adverse psychological consequences of being placed on early recall (6 or 12 months recall rather than 3 years) at T1. These effects were measured using the PCQ negative scale which has 12 items on a four-point Likert scale (scored 0-3).…”

“…55,59,[103][104][105][106] One study looked at the impact of having a false-positive screening mammogram among a population of women with a FHBC. 101,102,107 Five studies looked at the impact on returning for routine mammography screening 59,61,103,108,109,115 and two studies investigated the impact of written information on distress or reattendance.…”

Moderators of Psychological Recovery from Benign Cancer Screening Results

“…This 12-item scale is a valid and reliable tool that was developed specifically for breast cancer screening settings [11][12][13] . A 5-point response scale, ranging from 0 ("not at all") to 4 ("quite a lot of the time"), was used, and the mean score for each subscale was computed.…”

“…Thus, a large number of women are told during diagnostic testing that they do not, in fact, have breast cancer. There is robust evidence showing that, despite alleviation of the immediate threat of cancer, women who receive a benign diagnosis report persistent anxiety and other manifestations of psychological distress particularly intensely during the first 3-4 months after the diagnostic procedure [4][5][6][7][8][9][10][11][12][13] . In fact, recent research has shown that, compared with control subjects, these women report distress up to 8 months after the benign outcome 4 .…”