Fast Mammogram Follow-Up Lessens Anxiety
Immediate Follow-Up Tests Ease Pain of Abnormal Mammogram
April 6, 2004 -- It's a common high-anxiety moment: The doctor says your mammogram is abnormal.
Usually, this happens in a telephone call long after a woman has left the mammography clinic. Fortunately, it rarely means a woman has breast cancer. Ninety-five out of every 100 abnormal screening mammograms are false alarms.
But these false alarms take a toll. Aside from the time and expense of follow-up tests, the false-positive mammograms mean going back to the clinic for more tests. Even when a woman finds out she doesn't have cancer, the anxiety can linger.
What if a woman didn't have to wait to get follow-up tests? A research team led by Mary B. Barton, MD, of Harvard Medical School and Harvard Pilgrim Health Care, Boston, now has an answer.
"Our findings indicate that women with abnormal mammograms who receive an immediate radiology review of their mammograms have less anxiety about the mammogram than do women who do not receive immediate radiology review," Barton and colleagues report.
The findings appear in the April 7 issue of the Journal of the National Cancer Institute.
Making Mammograms Less Scary
The whole point of screening mammograms is to find early-stage breast cancers. It would be great if that were all they did. But mammograms often yield abnormal results. Far more often than not, these are false alarms. Most of the time, follow-up tests by a radiologist are all it takes to find out whether there's a problem. Sometimes, however, a suspicious lump has to be biopsied.
It's not practical to schedule same-day biopsies. But it is possible for at least some clinics to schedule other same-day follow-up tests. That's just what Barton and colleagues did at seven Boston-area mammogram clinics. They also developed an educational program -- including a nine-minute videotape and a 10-page pamphlet -- designed to ease women's worries.
Their study enrolled 8,543 women who got screening mammograms. Only 41 of them turned out to have cancer; these women were not included in the final study results. The remaining women were randomly assigned to the educational program, to immediate radiology consultation, to both, or to neither.
About half the women who got false-positive mammograms -- and 28% of women with normal mammograms -- reported symptoms of anxiety. Even three months after a false-positive mammogram, more than one in four women still felt anxious.
Seeing the radiologist right after a false-positive mammogram significantly reduced women's anxiety. In fact, about half the women who did this later thought they'd had a normal mammogram in the first place.
The educational brochure and videotape didn't help.
"It is possible that different types of interventions, such as direct counseling by a health professional, would be needed to achieve a substantial reduction in women's anxieties related to breast cancer," Barton and colleagues suggest.
The researchers note that giving women immediate radiology review would increase the cost of mammograms. Would it be worth it? A cost-benefit study might offer some answers, Barton and colleagues suggest.
SOURCE: Barton, M.B. Journal of the National Cancer Institute, April 7, 2004; vol 96: pp 529-538.