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The Background Review for the USPSTF Recommendation on Screening for Breast Cancer FREE

Jessica T. DeFrank, MPH; and Noel T. Brewer, PhD
[+] Article and Author Information

From University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC 27599.


Potential Conflicts of Interest: None disclosed.


Ann Intern Med. 2010;152(8):537-538. doi:10.7326/0003-4819-152-8-201004200-00197
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TO THE EDITOR:

Two recent USPSTF statements on screening for breast cancer identify the harms of false-positive mammography screening test results, including psychological distress (12). Unfortunately, the reports drift away from published evidence about psychological distress from false-positive mammograms. The summary report dismisses the problem: “Anxiety, distress, and other psychosocial effects can exist with abnormal mammography results but fortunately are usually transient” (1). We believe that this statement mischaracterizes the empirical literature, and indeed what the USPSTF reports to an extent in its own detailed concurrent report (2), which more correctly states that “[f]alse-positive mammography results had no consistent effect on most women's general anxiety and depression but increased breast cancer–specific distress, anxiety, apprehension, and perceived breast cancer risk for some” (2). This statement is consistent with our own recent research, in which we found that false-positive mammography results cause small but reliable elevations in breast cancer–specific distress (3).

The USPSTF summary also comes to a different conclusion about transience of the effects of false-positive mammograms (12) than 2 previous systematic reviews (45). Brett and colleagues state that “[w]omen who have further investigations following their routine mammogram experience significant anxiety in the short-term, and possibly in the long-term” (4). They did not emphasize the transient effects of false-positive results as a general finding. Similarly, our own systematic review concluded that the effects of false-positive mammography results endure over the long term, well after cancer has been ruled out (5). We believe that the correct conclusion is that false-positive mammography results cause small but reliable levels of distress that endure for months and years.

Jessica T. DeFrank, MPH

Noel T. Brewer, PhD

University of North Carolina at Chapel Hill, Gillings School of Global Public Health

Chapel Hill, NC 27599

References

U.S. Preventive Services Task Force.  Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009; 151. PubMed
 
Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L, U.S. Preventive Services Task Force.  Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009; 151. PubMed
 
Salz T, Richman A, Brewer NT.  The long-term consequences of false-positive mammograms on outcomes specific to breast cancer. Psycho-Oncology. 2010. [Forthcoming].
 
Brett J, Bankhead C, Henderson B, Watson E, Austoker J.  The psychological impact of mammographic screening. A systematic review. Psycho-Oncology. 2005; 14:917-38. PubMed
CrossRef
 
Brewer NT, Salz T, Lillie SE.  Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med. 2007; 146:502-10. PubMed
 

Figures

Tables

References

U.S. Preventive Services Task Force.  Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009; 151. PubMed
 
Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L, U.S. Preventive Services Task Force.  Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009; 151. PubMed
 
Salz T, Richman A, Brewer NT.  The long-term consequences of false-positive mammograms on outcomes specific to breast cancer. Psycho-Oncology. 2010. [Forthcoming].
 
Brett J, Bankhead C, Henderson B, Watson E, Austoker J.  The psychological impact of mammographic screening. A systematic review. Psycho-Oncology. 2005; 14:917-38. PubMed
CrossRef
 
Brewer NT, Salz T, Lillie SE.  Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med. 2007; 146:502-10. PubMed
 

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