Mammograms can save lives, but they can also make women pretty darn anxious along the way.
By Lauren Cahn
By the time you’ve had your 10th annual mammogram, your chances are 50/50 that at least one will been a false-positive, according to the American Cancer Society. (Here are seven questions to ask your doctor when you have an abnormal mammogram.) A false-positive mammogram looks abnormal and requires additional testing (whether another mammogram, an ultrasound, an MRI, or even a biopsy, or more than one of these), but no breast cancer is actually present. (Here are the signs of breast cancer you shouldn’t ignore.)
Although a false positive is definitely better news than an actual cancer diagnosis, it’s still a miserable experience. In fact, women who go through a false-positive mammogram are at least 10 to 20 percent more likely to begin taking prescription medication for anxiety or depression within three months afterward (compared with women who get an immediate clean bill of health), according to a study recently published in the journal, Medical Care.
The study was led by Joel Segel, PhD, a professor in the Department of Health Policy and Administration at Penn State University. Dr. Segel was aware of the connection between false-positives and anxiety but wanted to go a step further and determine the extent of that anxiety—whether it tends to rise to the level of needing to see a doctor and starting meds.
Using insurance-claims databases (both commercial insurance and Medicaid), Dr. Segel and his team of researchers identified women between the ages of 40 to 64 who underwent mammography screening and had no prior insurance claims for anxiety or depression meds. The researchers then looked at which women got false-positive versus immediate negative results, and which women began taking meds within the following three months.
What the researchers found was that the longer it took for the false-positive to be resolved, the greater a woman’s likelihood of her going on meds. Similarly, the more tests a woman had to undergo to resolve the false-positive, the greater that likelihood was. Overall, if a woman had to undergo more than one follow-up test, the likelihood of starting meds zoomed to 20 to 30 percent. This increase was particularly noticeable among women with commercial insurance (as opposed to Medicaid). The highest likelihood of having to start meds was observed in women whose false-positive led to a biopsy.
Women under the age of 50 seem to be particularly vulnerable to experiencing clinically significant anxiety or depression in connection with a false-positive mammogram, the study also revealed. Although the study’s limitations make it impossible for the researchers to know why this would be, Dr. Segel offered a possible hypothesis to Reader’s Digest: For most of the women under age 50, this may have been their first experience with a false-positive, and that may have contributed to the anxiety. If a woman has already experienced a false-positive, it may be less traumatic.
Although the women tended to be on meds for only a short period of time, Dr. Segel says, the fact that they had to go on meds at all is evidence that the level of psychological discomfort associated with a false-positive is significant enough that we should be finding solutions. Given that regular breast cancer screening is critical to early detection, and false-positives are part of that picture, the take-away here is: “we want to be sure that women are getting the appropriate follow-up care to ensure that any concerns are dealt with,” he adds. “We want to encourage women to continue screening,” as opposed to scaring them off.
Specifically, Dr. Segel sees this as an example of how “patient-centered care” can be beneficial. “Discussing the results with patients and making sure they understand what the results mean and what the next steps are is essential, as is making sure that follow-up testing is scheduled and provided in a timely manner.”
If you find yourself on the business-end of an abnormal mammogram, here are the questions you’ll want to ask your clinician to help ensure that the follow-up testing process goes smoothly and as worry-free as possible.
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