Background In the UK women aged 47–73 are invited for screening by mammography every three 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 these 73% attended a screening clinic. Of these 64,104 were recalled for assessment. Of those recalled 81% did not have breast cancer, these women had a false-positive mammogram. The aim of this systematic review was to identify the psychological impact of false-positive screening mammograms and evidence for the effectiveness of interventions designed to reduce this.
Methods This was a systematic review using the principles of the Centre for Reviews and Dissemination in York.
All UK controlled studies and qualitative studies of women with a false-positive screening mammogram were included. The control group participants had normal mammograms. All psychological outcomes including returning for routine screening were permitted. Titles and abstracts were screened independently by two reviewers. Retrieved papers were reviewed and selected using the same independent process. Data were extracted by one reviewer and checked by another. Each included study was assessed for risk of bias.
Results The searches returned seven includable studies (7/4,423). Those using disease specific measures found that there could be enduring distress that lasted up to three years; the level of distress was related to the degree of invasiveness of the assessment. At three years the relative risks were, further mammography 1.28 (95% confidence interval 0.82 to 2.00), fine needle aspiration 1.80 (95% confidence interval 1.17 to 2.77), biopsy 2.07 (95% confidence interval 1.22 to 3.52). There was also an enduring impact for those put on early recall 1.82 (95% confidence interval 1.22 to 2.72), However, studies that used generic measures of anxiety and depression found no such impact up to three months after screening. The strongest evidence suggests that women with false-positive mammograms have an increased likelihood of failing to reattend for routine screening, relative risk 0.97 (95% confidence interval 0.96 to 0.98) compared to women with normal mammograms. No studies of women from different socio-economic or ethnic groups were found nor any published qualitative studies.
Conclusion Having a false-positive screening mammogram can cause breast cancer specific distress for up to three years. It is less likely there will be general anxiety or depression detectable at pathological levels. The degree of distress is related to the invasiveness of the assessment. Women with false-positive mammograms are less likely to return for routine assessment than those with normal ones.
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