Systematic review: The long-term effects of false-positive mammograms

Background: Although abnormal screening mammograms deleteriously affect the psychological well-being of women during the time immediately surrounding the tests, their long-term effects are poorly understood. Purpose: To characterize the long-term effects of false-positive screening mammograms on the behavior and well-being of women 40 years of age or older. Data Sources: English-language studies from the MEDLINE, Web of Science, EMBASE, CINAHL, PsycINFO, and ERIC databases through August 2006. Study Selection: Studies were identified that examined the effects of false-positive results of routine screening mammography on women's behavior, well-being, or beliefs. Data Extraction: Two investigators independently coded study charactedstics, quality, and effect sizes. Data Synthesis: 23 eligible studies (n = 313 967) were identified. A random-effects meta-analysis showed that U.S. women who received false-positive results on screening mammography were more likely to return for routine screening than those who received normal results (risk ratio, 1.07 [95% Cl, 1.02 to 1.121). The effect was not statistically significant among European women (risk ratio, 0.97 [Cl, 0.93 to 1,011), and Canadian women were less likely to return for routine screening because of false-positive results (risk ratio, 0.63 [Cl, 0.50 to 0.801). Women who received false-positive results conducted more frequent breast self-examinations and had higher, but not apparently pathologically elevated, levels of distress and anxiety and thought more about breast cancer than did those with normal results. Limitations: Correlational study designs, a small number of studies, a lack of clinical validation for many measures, and possible heterogeneity. Conclusions: Some women with false-positive results on mammography may have differences in whether they return for mammography, occurrence of breast self-examinations, and levels of anxiety compared with women with normal results. Future research should examine how false-positive results on mammography affect other outcomes, such as trust and health care use.