Breast cancer risk, worry, and anxiety: Effect on patient perceptions of false-positive screening results

Janie M Lee,Kathryn P Lowry,Jessica E Cott Chubiz,J Shannon Swan,Tina Motazedi,Elkan F Halpern,Anna N.A Tosteson,G Scott Gazelle,Karen Donelan

doi:10.1016/j.breast.2020.02.004

Abstract

ObjectiveThe impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall. MethodsWomen participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0–100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments. ResultsThe final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p < 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p < 0.05). ConclusionsWomen with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen.

Highlights

Mammography is the current standard for breast cancer screening as it has been shown to decrease breast cancer mortality in the general population [1,2]
QOL ratings did not vary by risk group for any of the presented scenarios across breast cancer risk groups (Fig. 3)
Across all risk levels and all screening scenarios, QOL scores were significantly lower during the period of diagnostic uncertainty versus after benign results were received; on average, QOL scores increased by 16 after receipt of benign results compared to the period of uncertainty (p < 0.05 for all scenarios)

Summary

Introduction

Mammography is the current standard for breast cancer screening as it has been shown to decrease breast cancer mortality in the general population [1,2]. Studies that have examined the impact of false positive screening mammograms in average risk women have suggested that the consequences of screening recalls include increased worry about breast cancer, psychological distress, and anxiety [11e16]. The majority of these studies have suggested that these effects are transient, some studies suggest that even these short-term effects may affect health behaviors such as future screening decisions [17]. A survey of US women’s attitudes toward false-positive mammography results found that women largely view false-positive test results as an acceptable consequence of screening [18]

Methods

Results

Conclusion