Breast screening: adverse psychological consequences one month after placing women on early recall because of a diagnostic uncertainty. A multicentre study.
BACKGROUND
It was the original intention of the UK National Health Service Breast Screening Programme (NHSBSP) to place women who were not diagnosed with cancer on three yearly routine recall (RR). In 1994-5 approximately 16,500 women, aged 50 to 64, were placed on early recall (ER) at a shorter time interval, of which about 98% will have a normal result. This large number exceeds the expectations of the NHSBSP.


OBJECTIVE
To establish the adverse psychological consequences (PCs) for women one month after placement on ER because of a diagnostic uncertainty, and if detected, to suggest practical solutions to reduce them.


METHODS
Thirteen breast screening centres throughout the UK participated in the study. From March to October 1995 all women who were placed on ER because of a diagnostic uncertainty were identified and compared with groups of women placed on RR (after mammography, assessment, fine needle aspiration, and a benign biopsy). These women were invited to complete a postal questionnaire one month after they were placed on ER or RR. One reminder was sent.


RESULTS
Overall 75% of women completed the questionnaire. The adverse PCs of placing women on ER because of a diagnostic uncertainty were higher (63%; n = 81 of 130) than those of women placed on RR after mammography (29%; n = 38 of 130) (P < 0.00001) or assessment (50%; n = 64 of 128) (P < 0.05), but lower than the adverse PCs of women who underwent a benign biopsy (87%; n = 26 of 30) (P < 0.05). Factors that were significantly associated with subsequent adverse PCs were identified.


CONCLUSIONS
The adverse PCs of being placed on ER because of a diagnostic uncertainty were significantly higher than those of women who turned out to have a false-positive mammographic result after assessment. Possible practical solutions are discussed.
Ong
G
G
CRC Primary Care Education Research Group, Oxford, United Kingdom.
Austoker
J
J
Brett
J
J
D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000523:psychology*; D010865:Pilot Projects; D011795:Surveys and Questionnaires