Psychological harm of false-positive mammography persists for years
Apart from the controversy over the timing and frequency of screening mammography, practitioners must bear in mind that the psychological effects of false-positive findings can last for years and be as psychologically disturbing as a confirmed diagnosis of breast cancer. A study just published in Annals of Family Medicine confirms long lasting psychosocial harm from false-positive mammography results. Previously only shorter term effects had been investigated:
"Cancer screening programs have the potential of intended beneficial effects, but they also inevitably have unintended harmful effects. In the case of screening mammography, the most frequent harm is a false-positive result. Prior efforts to measure their psychosocial consequences have been limited by short-term follow-up, the use of generic survey instruments, and the lack of a relevant benchmark—women with breast cancer."
The authors recruited 454 women with abnormal findings in screening mammography with both false and true positive results and matched each to 2 women with normal screening results. All the subjects completed the Consequences of Screening in Breast Cancer—a validated questionnaire encompassing 12 psychosocial outcomes—at the beginning and 1, 6, 18, and 36 months later. Specifically they scaled for psychosocial consequences that included sense of dejection, anxiety; negative impacts on behavior, sleep, sexuality; worry about breast cancer; deleterious effects on inner calm, social network and existential values:
"Six months after final diagnosis, women with false-positive findings reported changes in existential values and inner calmness as great as those reported by women with a diagnosis of breast cancer. Three years after being declared free of cancer, women with false-positive results consistently reported greater negative psychosocial consequences compared with women who had normal findings in all 12 psychosocial outcomes...The pattern of the 12 psychosocial outcomes in this prospective longitudinal study was consistent. At the time of screening and at 1, 6, and 18 months after screening and final diagnosis, there were, in general, significant differences between the 3 screening groups: normal, false-positive, and true-positive results. Women with breast cancer experienced greater negative psychosocial consequences than women with false-positive findings, and these women experienced greater negative psychosocial consequences than women with normal findings...Part II was developed in particular to measure the long-term consequences of false-positive cancer screening results. Our findings from this part imply that the degree of change in inner calmness and existential values within the first half-year after final diagnosis were just as great for women with breast cancer as for women receiving false-positive findings. Furthermore, the changes in existential values within 3 years were still greater for those having false positives compared with those with normal findings."
These findings document a persistent detrimental impact on psychosocial health and inner well-being that should be addressed in case management. In addition to tools that may include healing imagery and cognitive behavioral therapy to manage tendencies to rumination, a comprehensive functional medicine assessment to objectively investigate treatable underlying predisposing causes with appropriate tests can relieve fear of the unknown and provide a basis for confidence and increased peace of mind.
"False-positive screening mammography causes long-term psychosocial harm. In a period of 3 years after being declared free of cancer suspicion, women with false positives consistently reported greater negative psychosocial consequences compared with women with normal findings. The first half-year after final diagnosis, women with false positives reported changes just as great in existential values and inner calmness as women with breast cancer."