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

Abstract

Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Clinical Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/145/01. The contractual start date was in March 2011. The draft report began editorial review in November 2011 and was accepted for publication in June 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Background: In the UK, women aged 50-73 years are invited for screening by mammography every 3 years. In 2009-10, more than 2.24 million women in this age group in England were invited to take part in the programme, of whom 73% attended a screening clinic. Of these, 64,104 women were recalled for assessment. Of those recalled, 81% did not have breast cancer; these women are described as having a false-positive mammogram.

Elevated distress among patients undergoing screening for lung cancer

“…[24][25][26][27] These findings, however, generally indicate that minimal to moderate levels are reported during the screening process but subsequently decrease upon receipt of a non-cancerous finding. [24][25][26][27] Similar to other cancer types, participants in the present study experienced moderate levels of distress prior to being screened for lung cancer. However, unlike the published reports for breast and colon cancers, elevated distress scores were maintained among approximately 1/3 of the study's lung cancer screening patients, despite receipt of a non-concerning finding.…”

The impact of false positive breast cancer screening mammograms on screening retention: A retrospective population cohort study in Alberta, Canada

“…23,32 The third limitation is that about 8% of the biopsy data are estimated to be missing from the ASR database. This could lead to a slight underestimation of the odds of fail-torescreen for women who had benign biopsies, which means the reported effect size is likely to be conservative.…”

“…Both studies found significantly lower retention rates, 66.5% (Spain) and 45.8% (Alberta) for those who underwent invasive procedures, including aspiration, closed biopsy and/or open biopsy. 22 Invasive follow-up tests have been shown to create psychological distress in the context of false positive breast cancer screens, 23 which can last for up to three years; 7,24 it is likely that psychological distress plays an important role in screening retention.…”

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

“…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.…”