Women who have a false-positive mammogram result -- when breast cancer is first suspected but then dispelled with further testing -- can have lingering anxiety and distress up to three years after the misdiagnosis, a new study finds.
The emotional fallout is probably so long-lasting, "because the abnormal screening result is seen as a threat to your own mortality," said study author Dr. John Brodersen, a researcher at the University of Copenhagen in Denmark.
The report is published in the March-April issue of the Annals of Family Medicine.
False-positive mammograms are often cited by public health experts as a downside to mammography screening that needs to be considered when making recommendations about who should be screened, at what age and how frequently. They aren't uncommon: the risk of a false positive for every 10 rounds of screening ranges from 20 percent to 60 percent in the United States, Brodersen said.
After an abnormal mammogram, doctors typically order additional mammograms and, depending on those results, more tests such as an ultrasound or MRI, and finally a biopsy.
Studies about the short-term and long-term consequences of false-positive mammogram results have produced mixed findings, which Brodersen said spurred him to conduct his study. He evaluated more than 1,300 women, including 454 who had abnormal findings on a screening mammogram and others who received normal results.
Of those 454 who first had abnormal results, 174 later found they had breast cancer. Another 272 learned the result was a false positive. (Eight others were excluded from the study due to unknown conclusions or a diagnosis of cancer other than breast cancer.)
The women answered a questionnaire about their psychological state, such as their sense of calmness, being anxious or not about breast cancer and feeling optimistic or not about the future. They repeated the questionnaire at 1, 6, 18 and 36 months after the final diagnosis.
Six months after the final diagnosis, those with false positives had negative changes in inner calmness and in other measures as great as the women with breast cancer. Even at the three-year mark, women with false-positives had more negative psychological consequences compared with women with normal findings.
The differences among those with normal, false-positive and breast cancer findings only began to fade at the three-year mark, the study found.
Brodersen can't say if women who were more anxious about health or life in general to begin with were more likely to have long-term distress. "I have not investigated this aspect," he said.
Even without this information, the study is a good one, said Matthew Loscalzo, the Liliane Elkins Professor in Supportive Care Programs at the City of Hope Comprehensive Cancer Center in Duarte, Calif.
"They looked at large enough numbers, so the data they are sharing is valid and should be taken very seriously," he said.
The finding that some women are still stressed three years later does not surprise him, Loscalzo said. From his experience working with patients, Loscalzo said, women who receive a false-positive result do often feel at risk, even after getting the news they are cancer-free.
Many, he said, will definitely worry: "Will the next one be a breast cancer?"
In a statement released Monday, the American College of Radiology said, in part: "Anxiety regarding inconclusive test results is real and is only natural." However, the organization of radiologists also cited what it said are study flaws. For instance, the researchers did not take into account whether women with false-positive results had a family history of breast cancer, or whether some women were ordered to have more frequent mammograms, both of which would likely raise anxiety levels.
Women who get an abnormal mammogram result need support, Loscalzo said. Women who undergo additional testing after an abnormal mammogram should ask to get their results as soon as possible, he added. If they are feeling anxious, he suggests they also tell their doctor they want to talk with a counselor, he said.