Am Fam Physician. 1999 Aug 1;60(2):626-628.
The benefits of mammogram screening in women 50 to 69 years of age are well-established. Little potential exists for physical harm secondary to radiation exposure. However, the potential for psychologic distress after a mammogram is great. In one study, women who were recalled for abnormal mammograms experienced both emotional and physical dysfunction. Several studies have suggested that screening for breast cancer with mammographies could increase the incidence of cancer phobia and raise anxiety levels in these patients. Lowe and colleagues studied the effect of being recalled after an abnormal mammogram in women who were receiving mammograms as a screening procedure.
This was a matched prospective study of women who were recruited in a local community for mammography screening. Emphasis was placed on the concept that screening was for asymptomatic women only. All women to be screened completed a questionnaire before the procedure. Patients who were recalled for further views or repeat mammograms also completed a second questionnaire; each recalled woman was matched with a non-recalled woman according to variables such as age, marital status and education. The non-recalled matched women were mailed a second questionnaire at the same time as the recalled women. The final questionnaire was completed one month after the recall procedure. The questionnaire included aspects of the General Health Questionnaire and the Pyschological Consequences Questionnaire; other questions concerning the patient's “level of concern” were added. A total of 224 patients were recalled, with 182 patients ultimately completing all three questionnaires. There were no significant differences in age, race or other measures between those in the group of recalled patients who participated in the follow-up and those who were lost to follow-up.
Of the group recalled for further studies, 57 percent were under 50 years of age; 29 percent had had a prior mammogram. The recalled group was more likely than the matched group to report a palpable lump before mammography. On the questionnaire, members of the recalled group were more likely to indicate feeling negative consequences at the time of the repeat mammogram; however, there was no difference between groups after one month. The other portion of the questionnaire showed that the recall group reported a negative impact on their emotional, physical and social domains more than the patients who were not recalled. The level of concern was higher in the recall group than in the control group throughout the study. In the recall group, no breast cancer was discovered after the repeat mammogram.
The authors conclude that women need to be educated about why recall procedures are necessary in the early detection of breast cancer. Not surprisingly, women recalled after a screening mammogram experience a significant amount of emotional, physical and social distress. These feelings generally tend to be short-lived; however, the level of concern about breast cancer persists despite normal mammography results. Women also need to understand that even though they have been recalled, the chance of finding breast cancer is still small. Even if cancer were found, it would be in the early stages and amenable to cure. If these issues are addressed, women who are recalled for further mammography studies may be more likely to follow screening recommendations in the future.
Lowe JB, et al. Psychological distress in women with abnormal findings in mass mammography screening. Cancer. March 1, 1999;85:1114–8.
Copyright © 1999 by the American Academy of Family Physicians.
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