title: Women who are recalled for further investigation for breast screening: psychological consequences 3 years after recall and factors affecting re-attendance.
abstract: BACKGROUND
  In 1995-1996 a study was commenced investigating the experience of 'false-positive' women, i.e. who had undergone further investigations following routine breast screening and received a clear final result. These women were found to experience significantly greater adverse psychological consequences at 1 month, 5 months and 11 months after assessment compared with women who received a clear result after the initial basic mammogram. The present study follows up these 'false-positive' women 3 years later (at 35 months) just before being invited for their next routine breast screening. It investigates the effect of the previous experience of breast screening on adverse psychological consequences reported by false-positive women at this time, and explores factors that may be associated with the current adverse psychological consequences. Factors influencing attendance for the forthcoming appointment are reported, and the non-attendance rate is monitored.
  
  
  METHODS
  Women who had previously completed a questionnaire 1 month, 5 months and 11 months after their last breast screening 3 years ago, were invited to complete a postal questionnaire just before being invited to attend for their next routine mammogram 3 years later. Attendance for this appointment was monitored. A brief questionnaire was sent to non-attenders to ascertain their reasons for not attending.
  
  
  RESULTS
  The response rate was 77 per cent (387/505). Women who, at their last routine breast screening, had received a clear result after fine needle aspiration (FNA) at assessment, after a surgical biopsy or after a 6 month early recall appointment, all suffered significantly greater adverse psychological consequences at 1 month before returning for routine breast screening 3 years later than women who had received a clear result after the initial mammogram at their last routine breast screening. They were between 1.7 and 2 times more likely to suffer psychological consequences than women who received a clear result after their last mammogram. Women who had received a clear result at assessment without undergoing FNA reported higher psychological consequences than those who received a clear result after mammography, but the difference was not significant (relative risk 1.28, 95 per cent confidence interval 0.82-2.00). Fifteen per cent of those who had undergone assessment 3 years earlier did not attend their next routine breast screening appointment compared with 8 per cent of those who received a clear result after mammography (p = 0.035). Factors associated with adverse psychological consequences are reported.
  
  
  CONCLUSIONS
  Despite having received a final clear result during their previous routine breast screening 3 years ago, women who had undergone FNA, surgical biopsy or been placed on early recall suffered significantly greater adverse psychological consequences at 1 month before their next routine breast screening appointment than women who had received a clear result after their initial mammogram at their last routine breast screening. Having undergone further investigations did not necessarily motivate women to attend for their next routine appointment, with 15 per cent of these women not returning for routine screening 3 years on.
authors.affiliation: Division of Public Health and Primary Health Care, University of Oxford, Institute of Health Sciences, Headington.
authors.forename: J
authors.initials: J
authors.lastname: Brett
authors.forename: J
authors.initials: J
authors.lastname: Austoker
mesh_terms: D001007:Anxiety / Q000453:epidemiology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000523:psychology; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000523:psychology / Q000706:statistics & numerical data; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000523:psychology* / Q000706:statistics & numerical data; D008403:Mass Screening / Q000523:psychology* / Q000706:statistics & numerical data; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011788:Quality of Life; D013222:State Medicine; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D016387:Women's Health