Psychological Outcomes After a False Positive Mammogram: Preliminary Evidence for Ethnic Differences Across Time

Quality of Informed Consent in Mammography Screening-The Polish Experience

Breast cancer is one of the leading forms of cancers in women worldwide. In Poland, it accounts for approx. 20% of all cancers diagnosed, with approximately 11,000 new cases and 5000 deaths from this disease annually. To prevent unfavourable statistics, Poland introduced free breast cancer screening programmes, available to women aged 50-69. Over a million women take advantage of this programme each year. The aim of the research was to assess the quality of consent women give prior to mammography screening and address the question of whether this quality is sufficient to make an informed choice. The study was conducted on a representative group of 600 Polish women over 50 years old (475 of them had undergone mammography screening), who agreed to take part in the study. Using the computer-assisted interview technology (CATI) method, all women were asked about their perception of breast cancer and screening and those who had undergone mammography were quizzed about the consent process. They will form the focus of this research. The validated tool contained items on both the benefits and risks of screening. The results indicate that the quality of informed consent was insufficient. A discrepancy was observed in the awareness between the benefits and risks of mammography screening. The main motivations to undergo screening were: prophylactic purposes and the free-of-charge nature of this health service. Population-based screening programmes for breast cancer should be reconsidered in terms of information policy, and the quality of informed consent should be increased.

A systematic review to identify anxiety measures for use in populations undergoing abdominal aortic aneurysm screening

OBJECTIVE

To identify the most appropriate patient reported outcome measure (PROM) to quantify anxiety of participants in the United Kingdom (UK) National Abdominal Aortic Aneurysm Screening Programme (NAAASP).

METHODS

Comprehensive electronic searches were undertaken to identify studies reporting development or validation of PROMs used in the measurement of anxiety in screened populations. Study selection, data extraction and analysis were conducted independently by two reviewers; the "COnsensus-based Standards for the selection of health Measurement INstruments" (COSMIN) classification of measurement properties was used in the evaluation of included PROMs enabling a recommendation to be made for the most appropriate PROM for use in the NAAASP.

RESULTS

The systematic review identified three PROMS that met the specified quality criteria and of these the Psychological Consequences of Screening questionnaire (PCQ) was judged to be the most appropriate PROM for use in populations undergoing screening for abdominal aortic aneurysm (AAA). Though the PCQ was developed for use in breast screening the individual items are appropriate to a population undergoing screening for AAA with minimal modification.

DISCUSSION

The review was undertaken as part of a wider research initiative aiming to introduce routine measurement of anxiety alongside the UK NAAASP. A significant number of individuals participating in this screening programme will have an AAA that will never progress to a stage where it will directly cause ill health or require treatment. For these individuals the knowledge that they have an AAA could create anxiety that has a significant impact on quality of life, there is a potential for this to outweigh the benefits of screening and surveillance.

CONCLUSION

In the absence of a PROM with proven validity and reliability in populations undergoing AAA screening the PCQ is a pragmatic choice as a measure of anxiety in this population and appropriate for the purposes of the NAAASP.

Prenatal electrocardiogram testing and postpartum depression: A population-based cohort study

Background

Cardiovascular symptoms in pregnancy may be a clue to psychological distress. We examined whether electrocardiogram testing in pregnant women is associated with an increased risk of subsequent postpartum depression.

Methods

We conducted a population-based cohort study of pregnant women who delivered in Ontario, Canada comparing women who received a prenatal ECG to women who did not.

Results

In total, 3,238,218 women gave birth during the 25-year study period of whom 157,352 (5%) received an electrocardiogram during prenatal care. Receiving an electrocardiogram test was associated with a one-third relative increase in the odds of postpartum depression (odds ratio 1.34; 95% confidence interval 1.29–1.39, p < 0.001).

Conclusion

The association between prenatal electrocardiogram testing and postpartum depression suggests a possible link of organic disease with mental illness, and emphasizes that cardiovascular symptoms may be a clinical clue to the presence of an underlying mood disorder.

Errors in Mammography Cannot be Solved Through Technology Alone

Mammography has been the frontline screening tool for breast cancer for decades. However, high error rates in the form of false negatives (FNs) and false positives (FPs) have persisted despite technological improvements. Radiologists still miss between 10% and 30% of cancers while 80% of woman recalled for additional views have normal outcomes, with 40% of biopsied lesions being benign. Research show that the majority of cancers missed is actually visible and looked at, but either go unnoticed or are deemed to be benign. Causal agents for these errors include human related characteristics resulting in contributory search, perception and decision-making behaviours. Technical, patient and lesion factors are also important relating to positioning, compression, patient size, breast density and presence of breast implants as well as the nature and subtype of the cancer itself, where features such as architectural distortion and triple-negative cancers remain challenging to detect on screening. A better understanding of these causal agents as well as the adoption of technological and educational interventions, which audits reader performance and provide immediate perceptual feedback, should help. This paper reviews the current status of our knowledge around error rates in mammography and explores the factors impacting it. It also presents potential solutions for maximizing diagnostic efficacy thus benefiting the millions of women who undergo this procedure each year.

The Effect of False-positive Mammograms on Antidepressant and Anxiolytic Initiation

BACKGROUND

Despite reported increases in anxiety following a false-positive mammogram, there is little evidence the effect rises to the clinical level of initiating medication.

OBJECTIVE

To analyze the effect of a false-positive mammogram on antidepressant or anxiolytic initiation and identify subpopulations most at risk.

SUBJECTS

MarketScan commercial and Medicaid claims databases used to identify women ages 40-64 undergoing screening mammography with no prior antidepressant or anxiolytic claims.

RESEARCH DESIGN

Using a retrospective cohort design, we estimated the effects of a false-positive relative to a negative mammogram on the likelihood of initiating antidepressants or anxiolytics using multivariate logistic models estimated separately by insurance type.

RESULTS

At 3 months after a false-positive mammogram, the relative risk (RR) for antidepressant or anxiolytic initiation was 1.19 [95% confidence interval (CI), 1.06-1.31] for the commercially insured and 1.13 (95% CI, 0.96-1.29) in the Medicaid population. In addition, 4 subgroups were at particularly elevated risk: commercially insured women ages 40-49 (RR=1.33; 95% CI, 1.13-1.54) or whose false-positive required multiple tests to resolve (RR=1.37; 95% CI, 1.17-1.57), included a biopsy (RR=1.68; 95% CI, 1.18-2.17), or whose resolution took >1 week (RR=1.21; 95% CI, 1.07-1.34).

CONCLUSIONS

False-positive mammograms were associated with significant increases in antidepressant or anxiolytic imitation among the commercially insured. Follow-up resources may be particularly beneficial for cases taking longer to resolve and involving biopsies or multiple tests. The results highlight the need to resolve false-positives quickly and effectively and to monitor depressive symptoms following a positive result.