Consequences of false-positive screening mammograms
Open accessAbstract
IMPORTANCE: False-positive mammograms, a common occurrence in breast cancer screening programs, represent a potential screening harm that is currently being evaluated by the US Preventive Services Task Force. OBJECTIVE: To measure the effect of false-positive mammograms on quality of life by measuring personal anxiety, health utility, and attitudes toward future screening. DESIGN, SETTING, AND PARTICIPANTS: The Digital Mammographic Imaging Screening Trial (DMIST) quality-of-life substudy telephone survey was performed shortly after screening and 1 year later at 22 DMIST sites and included randomly selected DMIST participants with positive and negative mammograms. EXPOSURE: Mammogram requiring follow-up testing or referral without a cancer diagnosis. MAIN OUTCOMES AND MEASURES: The 6-question short form of the Spielberger State-Trait Anxiety Inventory state scale (STAI-6) and the EuroQol EQ-5D instrument with US scoring. Attitudes toward future screening as measured by women's self-report of future intention to undergo mammographic screening and willingness to travel and stay overnight to undergo a hypothetical new type of mammography that would identify as many cancers with half the false-positive results. RESULTS: Among 1450 eligible women invited to participate, 1226 (84.6%) were enrolled, with follow-up interviews obtained in 1028 (83.8%). Anxiety was significantly higher for women with false-positive mammograms (STAI-6, 35.2 vs 32.7), but health utility scores did not differ and there were no significant differences between groups at 1 year. Future screening intentions differed by group (25.7% vs 14.2% more likely in false-positive vs negative groups); willingness to travel and stay overnight did not (9.9% vs 10.5% in false-positive vs negative groups). Future screening intention was significantly increased among women with false-positive mammograms (odds ratio, 2.12; 95% CI, 1.54-2.93), younger age (2.78; 1.5-5.0), and poorer health (1.63; 1.09-2.43). Women's anticipated high-level anxiety regarding future false-positive mammograms was associated with willingness to travel overnight (odds ratio, 1.94; 95% CI, 1.28-2.95). CONCLUSIONS AND RELEVANCE: False-positive mammograms were associated with increased short-term anxiety but not long-term anxiety, and there was no measurable health utility decrement. False-positive mammograms increased women's intention to undergo future breast cancer screening and did not increase their stated willingness to travel to avoid a false-positive result. Our finding of time-limited harm after false-positive screening mammograms is relevant for clinicians who counsel women on mammographic screening and for screening guideline development groups.
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STAI has been used in breast, colon, and lung cancer screening programs and in patients with cirrhosis.
“which has been used in breast, colon, and lung cancer screening programs24–26 and in patients with cirrhosis.27”
From Depression and anxiety are common among patients with cirrhosis (2022) · cites this paper as [25]
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“) women more likely to return [28, 33, 35].”
- Authors
- Tosteson, A. N. A., Fryback, D. G., Hammond, C. S., Hanna, L. G., Grove, M. R., Brown, M., Wang, Q., Lindfors, K., & Pisano, E. D.
- Affiliations
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- University of Wisconsin–Madison (US)
- Brown University (US)
- University of North Carolina at Chapel Hill (US)
- University of California, Davis (US)
- Medical University of South Carolina (US)
- Corresponding author
- Tosteson, Anna N. A.
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2014-06-01
- Volume
- 174
- Issue
- 6
- Pages
- 954
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC4071565
- OpenAlex
- W1997495901
- Cited by
- 217
- References
- 37
- Citations by year
- 2026: 11 · 2025: 20 · 2024: 15 · 2023: 13 · 2022: 22 · 2021: 21 · 2020: 25 · 2019: 13 · 2018: 20 · 2017: 20 · 2016: 19 · 2015: 9 · 2014: 9
- FWCI
- 9.16
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- JAMA Internal Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (U0179778-S1)
- National Cancer Institute (U01CA079778, U10CA180820, U01-CA-80098, U01 CA79778, U54CA163307, U01CA080098, UC2CA148259, U01CA80098-S1, U10CA180794, RC2/UC2CA148259, P30CA023108)
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Digital Radiography and Breast Imaging
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- false-positive mammograms, breast cancer screening, health-related quality of life, health utility, screening intention, USPSTF screening recommendations, state anxiety, EQ-5D
- MeSH terms
- Aged, Anxiety, False Positive Reactions, Female, Follow-Up Studies, Humans, Mammography, Middle Aged, Quality of Life
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