Immediate Readings Associated with Less Anxiety For Women With Abnormal Mammograms
A ]]>mammogram]]> is an x-ray examination of the breast. It is used to detect and diagnose ]]>breast cancer]]> in women. Beginning at age 40, the American Cancer Society recommends a woman undergo screening mammography every year. Unfortunately, by the time a woman has had 10 mammograms, she will have a 50% chance of being told her results are abnormal, a finding which can understandably be the source of considerable anxiety for both the woman and her family.
However, an abnormal mammogram does not necessarily mean that a woman has breast cancer. Indeed, 5% to 11% of screening mammographies will result in an abnormal reading that requires further testing, and of these, 97% will later be found to be falsely positive. (This means that the radiologist who read the mammogram saw a suspicious change in the breast but no cancer was found when the women returned for more studies.)
Bearing in mind the high rate of false positives associated with screening mammography, a group of researchers set out to find an intervention strategy that would help ease women’s anxiety when faced with an abnormal mammogram. They compared two strategies: an educational intervention or a mammogram reading by a qualified radiologist at the time of the test. The results of their study, published in the April 7, 2004 issue of The Journal of the National Cancer Institute found that when it came to easing a woman’s fears, an immediate reading of their mammogram by a radiologist was more effective than an educational intervention.
About the Study
The researchers enrolled 8543 women aged 39 or older who were scheduled to undergo screening mammography, but had no history of breast cancer. Each woman was assigned to one of four intervention groups:
- Radiology intervention only
- Educational intervention only
- Both interventions
- Neither intervention
For the educational intervention, the women viewed a 9-minute videotape and received a pamphlet; both items were designed to reduce anxiety among women who had undergone screening mammography. For the radiology intervention, a qualified radiologist reviewed each woman’s films before she left the doctor’s office. (This is contrary to the usual method in which mammograms are reviewed in batches by a radiologist at some point after the woman has left the facility.)
In the end, 2390 women were interviewed via telephone both three weeks and three months after their mammogram.
The researchers found that among the women interviewed, 1439 had mammograms that were considered abnormal (meaning that their results required further testing, such as additional mammograms, ultrasounds, or biopsies). By three weeks after the initial screening, 1037 (72.1%) of these women had been informed that their abnormal mammogram was a false-positive. Despite this, 46.8% reported symptoms of anxiety three weeks after their initial mammogram. Whereas only 28.3% of the women whose mammograms had been determined normal reported any lingering feelings of anxiety.
By three months, as many as 80% of the women with abnormal mammograms had been informed that these readings were false-positives. However, 28% still reported feelings of anxiety related to the results of their mammogram.
Of the different interventions used, the study found that women who received an immediate review of their mammograms by a radiologist at the time of their exam experienced less anxiety three weeks after their mammogram than those who did not. By three months, however, reported anxiety levels were the same, regardless of the intervention used.
How Does This Affect You?
Finally, the researchers reported that three weeks after receiving an abnormal mammography reading, nearly 50% of the women reported lingering feelings of anxiety about their test, even though they were already aware that the test was a false positive. The study went on to show that this anxiety lingered for as long as three months in at least 28% of the women. Other research in this area has shown that this anxiety can linger for up to three years.
Although there is still some debate about the value of screening mammographies in reducing breast cancer mortality rates, research strongly suggests that the early detection of breast cancer by mammography greatly improves a patient’s chances of survival. This means that until something better comes along, screening mammography remains the single most effective method of early detection.
The challenge then is to strike a balance between maximizing the benefits associated with the early detection of cancer and minimizing the harm caused by screening mammography and its attendant high false positive rates. This study takes an important step in that direction.
American Cancer Society
National Cancer Institute
The Susan G. Komen Breast Cancer Foundation
Barton MB, Morley DS, Moore S, et al. Decreasing women’s anxieties after abnormal mammograms: A controlled trial. JNCI. 2004;96(7):529-538.
Breast Cancer Facts and Figures 2003-2004. The American Cancer Society. Available at: http://www.cancer.org/downloads/STT/CAFF2003BrFPWSecured.pdf . Accessed April 7, 2004.
Study Looks at Reasons for False-Positive Mammograms. The American Cancer Society. Available at: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Study . Accessed April 7, 2004.
Last reviewed April 9, 2004 by ]]>Richard Glickman-Simon, MD]]>
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