What is the psychological impact of mammographic screening on younger women with a family history of breast cancer? Findings from a prospective cohort study (PIMMS)

Background

It is not yet known whether the benefits of regular screening for women with a family history of breast cancer (FHBC) outweigh the harms. One of the harms associated with having a mammogram is recall for further tests such as additional imaging and biopsies [1]. This has been shown to cause significant anxiety in the short term, and possibly the long term, in women in routine screening [2]. Given the greater cancer worry in women with a FHBC [3], it is possible they may be particularly adversely affected by a recall. This multicentre, prospective study investigated both the positive and negative psychological effects of regular mammographic screening in women <50 years with a family history of breast cancer [4].

Methods

Women who received an immediate all-clear result after mammography (n = 1,174) and women who were recalled for further tests prior to receiving an all-clear result (false positive) (n = 112) completed questionnaires: 1 month before mammography, and 1 month and 6 months after receiving final results. The questionnaires included measures of cancer worry, psychological consequences and perceived benefits of breast screening.

Results

See Figure 1. Women who received an immediate all-clear result experienced a decrease in cancer worry and negative psychological consequences immediately post result, whereas women who were recalled for further tests did not. By 6 months this cancer-specific distress had reduced significantly in both groups. Changes in levels of distress were significantly different between the two groups, but in absolute terms the differences were not large. Recalled women reported significantly greater positive psychological consequences of screening immediately post-result, and were also more positive about the benefits of screening compared with women who received an immediate all-clear result.

Figure 1

Cancer Worry Score (CWS).

Conclusion

For women receiving an immediate all-clear result, participating in annual mammographic screening is psychologically beneficial. Furthermore, women who are recalled for further tests do not appear to be psychologically harmed by screening. Women's positive views about mammography suggest that they view any distress caused by recall as an acceptable part of screening.