Distressed or relieved? Psychological side effects of breast cancer screening in The Netherlands.

Abstract

Study objectives-To assess the psychological impact of mammographic screening on women with non-malignant outcomes after attending the Netherlands' National Breast Cancer Screening Programme. Design-During one year all women with false positive test results (95) in a screening area were invited for the study. Each false positive was matched with two women with normal mammograms with respect to age and municipality. A random reference group of 400 was drawn from the female population in an area not yet included in the screening programme. Experiences with screening and psychological status of subjects were assessed 8-10 weeks after screening (T1) and again after six months (T2), by interviews as well as questionnaires. References completed two questionnaires with a six months' interval. Participants-74 (78%) women with false positive outcomes and 113 (59%) women with negative outcomes participated at TI, of these 65 (88%) and 105 (93%) at T2, respectively; 238 references returned questionnaires at Ti (59%), of these 143 (60%) at T2.Main results-At 8-10 weeks after the screening, the women who received false positive test results scored higher on most of the variables indicating psychological disfunctioning than women with normal mammograms, but did not notably differ on the same variables from the nonscreened reference group. Women with normal mammograms had the lowest scores on all the variables in the study at both assessments. The same situation was observed six months later. Although 61% of the women who received false positive mammograms reported that they had experienced the "false alarm" as a stressful event, this experience had apparently no adverse effects on their psychological functioning, as assessed 8-10 weeks after screening. Conclusions-Overall, breast screening is not likely to generate adverse psychological effects in "healthy" women, even if the outcome is false positive. Differences in psychological functioning between false positives and negatives are more likely ascribable to feelings of relief in the negative group than to raised anxiety and distress in the false positive group. (7 Epidemiol Community Health 1997;51:705-7 10) Not only will the number of women who may benefit from regular mammography increase by the diffusion of population based screening, but also the number of women who may be affected by psychological side effects. Side effects can arise from different stages of the screening process, from the invitation for mammography confronting women with the possibility of having breast cancer to the diagnosis of a breast cancer that was not suspected. The comparatively few studies on the subject suggest that the psychological impact of breast screening followed by a negative outcome is negligible or non-existent in "psychologically healthy" women, but that a false positive outcome can cause emotional disturbances up till six months or more after being informed that the abnormal mammogram did not imply breast cancer."-3 Women with false positive outcomes and subsequent clin...

Participation behaviour following a false positive test in the Copenhagen mammography screening programme

“…Aro et al [6] argued that, although some shortterm distress after a positive result could be found, these are moderate, and that general cancer-specific distress is more of a problem. Scaf-Klomp et al [22] argued that a false-positive test does not cause adverse effects longer than 8Á10 weeks and that differences in psychological functioning between false positives and negatives rather was due to a sense of relief among the negatives. Other studies have indicated the presence of long-term effects, following a false positive result [3,4,6,7].…”

A retrospective audit of the first screening round of the Maltese breast screening programme

“…3,38 As this was the first unit on the island using direct digital mammography, radiologists were new to the equipment possibly leading to increased recall rates. 39 Such high recall rates may also arise from the local absence of consensus or arbitration of double reading. Other studies have suggested that double reading by consensus or arbitration, although being more labour intensive, decreases the recall rate.…”

“…37 One study found that 30% of recalled women felt very anxious on receipt of their recall letter, whilst another study reported that 40% of women reported feeling very frightened when they received their recall letter. 38,39 16% of respondents felt certain that they had breast cancer. 38,39 Such a psychological impact was reported by recalled women before 40 , during 41 , and immediately after recall.…”

“…38,39 16% of respondents felt certain that they had breast cancer. 38,39 Such a psychological impact was reported by recalled women before 40 , during 41 , and immediately after recall. 42 Women who had clear results after an invasive investigation and those who were placed on ER experienced the highest levels of anxiety.…”

Estrategias de afrontamiento y malestar emocional en mujeres con resultados dudosos de su mamografía de cribado

“…En esta misma línea, se ha hallado que no era probable que de manera global el cribado de cáncer de mama genere efectos psicológicos adversos en las mujeres sanas, incluso cuando el resultado era un falso positivo. Atribuyéndose las diferencias en el funcionamiento psicológico entre las mujeres con un resultado falso positivo y las mujeres con un resultado negativo con más probabilidad a sentimientos de alivio en el grupo cuyos resultados fueron negativos que a un aumento de la ansiedad y del malestar psicológico en el grupo al que se le dio un resultado falso positivo (26) . Comparándose mujeres que habían recibido un resultado falso positivo con mujeres que habían recibido resultados claros, tres y doce meses después de haber atendido a las pruebas posteriores se ha encontrado que no había diferencias con respecto a la ansiedad entre ambos grupos (27) .…”