False-Positive Mammogram Induces Transient Anxiety

The significance of anxiety related to false–positive mammogram results is tested

medwireNews: False-positive mammogram results cause “small, and transient” anxiety to patients, US researchers have found, but the concern does not discourage women from repeat screening.

Mammographic Imaging Screening Trial quality-of-life sub-study findings indicate that the 494 patients with a false–positive test had significantly higher Spielberger State–Trait Anxiety Inventory state scale scores during or shortly after work-up than the 534 patients interviewed after a negative test, at 35.2 versus 32.7.

But there was no significant difference in results for the EuroQol EQ-5D instrument for health utility between the groups at baseline, and no significant difference in anxiety was detected 1 year later at follow-up, report Anna Tosteson, from Geisel School of Medicine at Dartmouth in Lebanon, New Hampshire and co-workers.

Nevertheless, around 10% of participants reported a willingness for hypothetical travel with an overnight stay to undergo a novel form of mammography without the risk of false–positive results, with women with high levels of anxiety more willing to travel than those with lower levels of anxiety (odds ratio [OR]=1.94).

And 81.6% of women expressed a preference for a new form of mammography that would avoid false–positive results over a test with less breast compression.

Of note, women with a false-positive result were more likely to state an intention to undergo repeat screening than those with negative tests (OR=2.12), as were younger patients (OR=2.78) and those with poor health (OR=1.63).

“The fact that women’s anticipated anxiety about future false-positive mammograms was a correlate of willingness to travel and stay overnight to avoid such a result, but the actual experience of a false-positive mammogram was not, further highlights opportunities to educate women about screening outcomes,” the researchers comment in JAMA Internal Medicine.

And they recommend that “further research should address opportunities for reducing this anxiety”.

In an accompanying comment, Kurt Kroenke, from Indiana University in Indianapolis, USA, questions whether the harms of false–positive screening tests are minimal or meaningful, noting that women have a 10-year cumulative probability of a false–positive result of 61.3% with annual mammogram screening.

He writes that the study measures used by Tosteson et al may not be specific enough to detect test-related worries and that the 34.9% absolute increase in moderate anxiety among patients with a false–positive test versus those with a negative test could be considered a “meaningful harm”.

Also acknowledging recent reports of breast cancer overdiagnosis with mammograms, Kurt Kroenke concludes it is “critical to enhance patients’ understanding of screening, to engage patients in shared decision making, and to communicate and reconcile abnormal results in a patient-centrered and efficient fashion”.


Tosteson A, Fryback D, Hammond C, et al. Consequences of false-positive screening mammograms. JAMA Intern Med 2014; Advance online publication 21 April. doi:10.1001/jamainternmed.2014.981

Kroenke K. Are the harms of false-positive screening test results minimal or meaningful? JAMA Intern Med 2014; Advance online publication 21 April. doi:10.1001/jamainternmed.2014.160

medwireNews (www.medwireNews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014