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Original Investigation |

Consequences of False-Positive Screening Mammograms

Anna N. A. Tosteson, ScD1; Dennis G. Fryback, PhD2; Cristina S. Hammond, MPH1; Lucy G. Hanna, MS3; Margaret R. Grove, MS1; Mary Brown, MPH4; Qianfei Wang, MS1; Karen Lindfors, MD, MPH5; Etta D. Pisano, MD6
[+] Author Affiliations
1Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
2Departments of Population Sciences and Industrial and Systems Engineering, University of Wisconsin at Madison
3Center for Statistical Science, Brown University School of Medicine, Providence, Rhode Island
4Department of Radiology, University of North Carolina at Chapel Hill
5Department of Radiology, University of California at Davis
6Department of Radiology, Medical University of South Carolina, Charleston
JAMA Intern Med. 2014;174(6):954-961. doi:10.1001/jamainternmed.2014.981.
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Importance  False-positive mammograms, a common occurrence in breast cancer screening programs, represent a potential screening harm that is currently being evaluated by the US Preventive Services Task Force.

Objective  To measure the effect of false-positive mammograms on quality of life by measuring personal anxiety, health utility, and attitudes toward future screening.

Design, Setting, and Participants  The Digital Mammographic Imaging Screening Trial (DMIST) quality-of-life substudy telephone survey was performed shortly after screening and 1 year later at 22 DMIST sites and included randomly selected DMIST participants with positive and negative mammograms.

Exposure  Mammogram requiring follow-up testing or referral without a cancer diagnosis.

Main Outcomes and Measures  The 6-question short form of the Spielberger State-Trait Anxiety Inventory state scale (STAI-6) and the EuroQol EQ-5D instrument with US scoring. Attitudes toward future screening as measured by women’s self-report of future intention to undergo mammographic screening and willingness to travel and stay overnight to undergo a hypothetical new type of mammography that would identify as many cancers with half the false-positive results.

Results  Among 1450 eligible women invited to participate, 1226 (84.6%) were enrolled, with follow-up interviews obtained in 1028 (83.8%). Anxiety was significantly higher for women with false-positive mammograms (STAI-6, 35.2 vs 32.7), but health utility scores did not differ and there were no significant differences between groups at 1 year. Future screening intentions differed by group (25.7% vs 14.2% more likely in false-positive vs negative groups); willingness to travel and stay overnight did not (9.9% vs 10.5% in false-positive vs negative groups). Future screening intention was significantly increased among women with false-positive mammograms (odds ratio, 2.12; 95% CI, 1.54-2.93), younger age (2.78; 1.5-5.0), and poorer health (1.63; 1.09-2.43). Women’s anticipated high-level anxiety regarding future false-positive mammograms was associated with willingness to travel overnight (odds ratio, 1.94; 95% CI, 1.28-2.95).

Conclusions and Relevance  False-positive mammograms were associated with increased short-term anxiety but not long-term anxiety, and there was no measurable health utility decrement. False-positive mammograms increased women’s intention to undergo future breast cancer screening and did not increase their stated willingness to travel to avoid a false-positive result. Our finding of time-limited harm after false-positive screening mammograms is relevant for clinicians who counsel women on mammographic screening and for screening guideline development groups.

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