The Background Review for the USPSTF Recommendation on Screening for Breast Cancer
Authors: Jessica T. DeFrank
Journal: Annals of Internal Medicine (2010)

Letters20 April 2010The Background Review for the USPSTF Recommendation on Screening for Breast CancerFREEJessica T. DeFrank, MPH and Noel T. Brewer, PhDJessica T. DeFrank, MPHFrom University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC 27599.Search for more papers by this author and Noel T. Brewer, PhDFrom University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC 27599.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-8-201004200-00197 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Two recent USPSTF statements on screening for breast cancer identify the harms of false-positive mammography screening test results, including psychological distress (1, 2). Unfortunately, the reports drift away from published evidence about psychological distress from false-positive mammograms. The summary report dismisses the problem: “Anxiety, distress, and other psychosocial effects can exist with abnormal mammography results but fortunately are usually transient” (1). We believe that this statement mischaracterizes the empirical literature, and indeed what the USPSTF reports to an extent in its own detailed concurrent report (2), which more correctly states that “[f]alse-positive mammography results had no consistent effect on most women's general anxiety and depression but increased breast cancer–specific distress, anxiety, apprehension, and perceived breast cancer risk for some” (2). This statement is consistent with our own recent research, in which we found that false-positive mammography results cause small but reliable elevations in breast cancer–specific distress (3).The USPSTF summary also comes to a different conclusion about transience of the effects of false-positive mammograms (1, 2) than 2 previous systematic reviews (4, 5). Brett and colleagues state that “[w]omen who have further investigations following their routine mammogram experience significant anxiety in the short-term, and possibly in the long-term” (4). They did not emphasize the transient effects of false-positive results as a general finding. Similarly, our own systematic review concluded that the effects of false-positive mammography results endure over the long term, well after cancer has been ruled out (5). We believe that the correct conclusion is that false-positive mammography results cause small but reliable levels of distress that endure for months and years.Jessica T. DeFrank, MPHNoel T. Brewer, PhDUniversity of North Carolina at Chapel Hill, Gillings School of Global Public HealthChapel Hill, NC 27599References1. U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26, W-236. [PMID: 19920272] MedlineGoogle Scholar2. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L; U.S. Preventive Services Task Force. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:727-37, W237-42. [PMID: 19920273] LinkGoogle Scholar3. Salz T, Richman A, Brewer NT. The long-term consequences of false-positive mammograms on outcomes specific to breast cancer. Psycho-Oncology. 2010. [Forthcoming]. Google Scholar4. Brett J, Bankhead C, Henderson B, Watson E, Austoker J. The psychological impact of mammographic screening. A systematic review. Psycho-Oncology. 2005;14:917-38. [PMID: 15786514] CrossrefMedlineGoogle Scholar5. Brewer NT, Salz T, Lillie SE. Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med. 2007;146:502-10. [PMID: 17404352] LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC 27599.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: The Long-Term Effects of False-Positive Mammograms Noel T. Brewer , Talya Salz , and Sarah E. Lillie Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation StatementScreening for Breast Cancer: An Update for the U.S. Preventive Services Task Force Heidi D. Nelson , Kari Tyne , Arpana Naik , Christina Bougatsos , Benjamin K. Chan , and Linda Humphrey When Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningThe Background Review for the USPSTF Recommendation on Screening for Breast Cancer Karsten J. Jørgensen and Peter C. Gøtzsche The Background Review for the USPSTF Recommendation on Screening for Breast Cancer Heidi D. Nelson , Arpana Naik , Linda Humphrey , and Kari Tyne The Background Review for the USPSTF Recommendation on Screening for Breast Cancer Kay Dickersin , David Tovey , Nicholas Wilcken , and Davina Ghersi Metrics Cited ByUpdate: Estrogen and Estrogen plus Progestin Therapy in the Care of Women at and after the MenopauseWhen Evidence Collides With Anecdote, Politics, and Emotion: Breast Cancer ScreeningThe Editors 20 April 2010Volume 152, Issue 8Page: 537-538KeywordsAnxietyBreast cancerCancer screeningConflicts of interestMammographyRisk managementSystematic reviews ePublished: 20 April 2010 Issue Published: 20 April 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...