Systematic Review: The Long-Term Effects of False-Positive Mammograms

3 April 2007 | Volume 146 Issue 7 | Pages 502-510

Background: Although abnormal screening mammograms deleteriously affect the psychological well-being of women during the time immediately surrounding the tests, their long-term effects are poorly understood.

Purpose: To characterize the long-term effects of false-positive screening mammograms on the behavior and well-being of women 40 years of age or older.

Data Sources: English-language studies from the MEDLINE, Web of Science, EMBASE, CINAHL, PsycINFO, and ERIC databases through August 2006.

Study Selection: Studies were identified that examined the effects of false-positive results of routine screening mammography on women's behavior, well-being, or beliefs.

Data Extraction: Two investigators independently coded study characteristics, quality, and effect sizes.

Data Synthesis: 23 eligible studies (n = 313 967) were identified. A random-effects meta-analysis showed that U.S. women who received false-positive results on screening mammography were more likely to return for routine screening than those who received normal results (risk ratio, 1.07 [95% CI, 1.02 to 1.12]). The effect was not statistically significant among European women (risk ratio, 0.97 [CI, 0.93 to 1.01]), and Canadian women were less likely to return for routine screening because of false-positive results (risk ratio, 0.63 [CI, 0.50 to 0.80]). Women who received false-positive results conducted more frequent breast self-examinations and had higher, but not apparently pathologically elevated, levels of distress and anxiety and thought more about breast cancer than did those with normal results.

Limitations: Correlational study designs, a small number of studies, a lack of clinical validation for many measures, and possible heterogeneity.

Conclusions: Some women with false-positive results on mammography may have differences in whether they return for mammography, occurrence of breast self-examinations, and levels of anxiety compared with women with normal results. Future research should examine how false-positive results on mammography affect other outcomes, such as trust and health care use.

Editors' Notes Context Do false-positive mammograms affect women's well-being and behavior? Contribution This systematic review summarizes data from 23 observational studies that compared outcomes after false-positive results or normal results on screening mammograms. Women who received false-positive results had slightly higher levels of distress and more thoughts about cancer several months after screening than women who received normal results. They also performed breast self-examinations more frequently and, in the United States, were slightly more likely to return for repeated routine screening examinations (risk ratio, 1.07 [95% CI, 1.02 to 1.12]). Implication False-positive mammograms may have persistent small effects on some women's psychological well-being and behavior. —The Editors

 

Author and Article Information

From the University of North Carolina, Chapel Hill, North Carolina.

Note: Portions of this paper were presented at the 2006 meetings of the American Society for Preventive Oncology, Bethesda, Maryland, 26–28 February 2006; the Society for Behavioral Medicine, San Francisco, California, 22–25 March 2006; and the Society of Judgment and Decision Making, Houston, Texas, 17–20 November 2006.

Acknowledgments: The authors thank colleagues who provided feedback on the study results and on earlier drafts of the manuscript.

Grant Support: By the University of North Carolina Lineberger Comprehensive Cancer Center and the American Cancer Society (MSRG-06-259-01-CPPB).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Noel Brewer, PhD, Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, 306 Rosenau Hall CB#7440, Chapel Hill, NC 27599; e-mail, ntba{at}unc.edu.

Current Author Addresses: Dr. Brewer, Ms. Salz, and Ms. Lillie: Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, 306 Rosenau Hall CB#7440, Chapel Hill, NC 27599.

Read all Rapid Responses

Most women start screening at age 50

Berta M. Geller, et al.

Annals Online, 9 Apr 2007 [Full text]

Any current conclusions about the psychosocial long-term consequences must remain tentative

John Brodersen, et al.

Annals Online, 26 Apr 2007 [Full text]

Response to letters

Noel Brewer, et al.

Annals Online, 24 May 2007 [Full text]