Women should be fully informed of the potential benefits and harms before screening mammography.

Abstract

Based on their survey of women's attitudes about screening mammography, Schwartz and colleagues conclude that women are knowledgeable of the chance of a false-positive result and accept this risk as a consequence of undergoing screening mammography. It is not clear, however, whether the authors accurately assessed women's true tolerance of false-positive mammography results because their survey did not describe the spectrum of physical and psychological sequelae of a false-positive result (for example, additional diagnostic evaluations and associated morbidity and anxiety).1,2,3 Thus, the proportion of women who are tolerant of false-positive mammography results may have been overestimated because the possible harms of screening mammography were not fully described. Even so, 38% of women surveyed indicated that they would want to factor information about the consequences of false-positive results into their decision about undergoing screening mammography. If nearly 2 of every 5 women desire such information, then they should be informed of the possible harms, as well as the benefits, of screening mammography. The authors attempt to bolster their conclusion by reporting that women who had both a positive mammography result and subsequent benign findings on tissue biopsy expressed the same high tolerance for false-positive results as all of the women surveyed. However, women who have positive mammography results that subsequently lead to biopsy account for only 25% of women with false-positive results.4 Thus, these women's tolerance of false-positive results may not accurately reflect the views of all women who have false-positive results. Women who undergo breast biopsy for positive results are often so relieved when they find out that they do not have breast cancer that they might understandably—but somewhat ironically—have a high tolerance of false-positive results.