The number of false positives from mammograms are a major issue in the breast cancer screening debate. When a mammogram identifies an abnormality that looks like a cancer but turns out to be normal, it's called a false positive.
Ultimately the news is good: No breast cancer. But there is a cost to false positives: psychological stress and extra tests and procedures. A false positive requires follow-up with one or more doctors and usually more tests. The study reviewed here underscores what many women know: Worrying that you might have breast cancer and waiting to find out for sure causes a huge amount of anxiety.
No screening test is perfect. A screening can raise a false alarm when there is no problem. A screening also can falsely reassure when there is a major problem. Mammograms are no exception. To make up for these limitations, you need more than mammography. You also need to:
This challenge that comes with breast cancer screening is NOT a good reason to delay or give up screening. The challenge should motivate doctors to find even better ways to screen for breast cancer—techniques that minimize false positives and false negatives.
In the meantime, you can minimize how a possible false alarm affects you and maybe even lower the risk of a false alarm in the first place.
NEW YORK (Reuters Health) - Women who are told their mammogram shows a possible cancer that turns out to be a false alarm are likely to suffer anxiety for a long time, according to a new study.
"U.S. women who get a false-positive are more likely to come back for their next routine screen," lead author Dr. Noel T. Brewer, of the University of North Carolina at Chapel Hill, told Reuters Health. "On the face of it, this seems like a good thing, but scaring women for long periods of time to get them to screen again does not seem like the best approach."
Brewer and colleagues conducted an analysis of 23 studies showing the effects of false-positive results of mammography on women. The studies involved a total of 313,967 women aged 40 and older.
Women who were given a false-positive mammogram result performed breast self-exams more frequently than other women, the investigators report in the Annals of Internal Medicine.
American women who had received false-positive results were more likely to return for routine screening, Canadian women were less likely, and European women were statistically uninfluenced by a false-positive result in their adherence to follow-up exams.
The Chapel Hill team found higher levels of anxiety and distress among women who received false-positive mammograms. "These effects last for many years," Brewer noted. "Although their anxiety is not generalized or at the level that requires medical intervention, it is an unnecessary consequence of poor medical care."
False-positives are "harming women's well-being," Brewer said. "The U.S. needs to substantially improve its mammography screening practices."
Drs. Joann G. Elmore and John H. Choe of the University of Washington, Seattle, comment in an accompanying editorial that breast cancer screening decisions are a "complex knot of social, political and economic forces."
"No simple screening recommendation applies to all women in their forties," they note. Listening to patients and good communication about the limitations and benefits of these "imperfect tests" is necessary.
SOURCE: Annals of Internal Medicine, April 3, 2007.
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