Mammograms and Anxiety: Breast Cancer Screening Shouldn't Make You Anxious

Many women refuse to get screened for breast cancer, done by a mammogram, purely out of fear for the results. Often times, false-positives can be a result of these screenings, which can cause psychological stress on the patient until the time comes when their results are cleared up.

However, the American Cancer Society's new guidelines on screening state that false-positive mammography is an "important, but not critical outcome" when deciding whether or not women should get screened. The new guidelines suggest screening start at age 45, instead of 40, and that regular screenings could occur less often. 

Researchers from the University of Colorado's Anschutz Medical School attempted to find a way to reduce this anxiety that women face about getting screened by examining 117 participants who attended a public informational talk about the the logistics and outcomes of mammography, hosted by a trained radiologist. 

The study saw that out of the 117 participants, their mean score on a 1-to-5 scale of anxiety decreased by a mean of four points after attending the talk.

"Our question was, if the ACS - and before them the U.S. Preventative Task Force - considered anxiety a harm that could prevent screening, how could we minimize that harm," said Dr. Lara Hardesty, an associate professor of Radiology-Diagnostics and one of the paper's co-authors. Hardesty and her co-author, Dr. Jiyon Lee of New York University, hypothesized that the more the participants knew, the less anxious they would be about the screenings.

They administered questionnaires before the informational talk and found that 56 percent of the participants were worried about unknown results. They also discovered that 22 anticipated pain during the procedure; 15 percent were worried about how known risk factors would influence the likelihood of a positive diagnosis; 13 percent were anxious about general uncertainty; 9 percent were anxious about the wait for results; and 4 percent were nervous about the possibility of needing additional procedures.

"Our intention was to teach women what to expect from having a mammogram done and what to expect if you are called back for further testing," Hardesty said. "This happens to 10 percent of women, and we wanted them to know that a positive screening mammogram doesn't mean you definitely have cancer."

The U.S. Preventative Task Force stated that false-positives are actually fairly common with mammograms, occuring around half of the time.

After the talk, which took place over an hour, a follow up questionnaire showed that participants could now correctly provide reasons for screening, knowledge about the difference between the need for additional tests and an actual cancer diagnosis, the benefits of negative screenings as a baseline for later, and physical examinations. On a scale of 1-to-5, gains in understanding rated at a 4.7, reduced anxiety at 4.0, and encouragement to get screened at 4.6.

"There is a major difference between the concepts of over-diagnosing and over-treating breast cancer," Hardesty said. "I personally have found breast cancers on the screening mammograms of many women from ages 40 to 45, whose cancers tend to be of a type that grow rapidly and act aggressively." 

The researchers hope that the study soothes the anxiety women get about mammography, and still recommend that it is the best way to catch cancers in early, treatable stages.

"In cases where mammography discovers a cancer that is unlikely to be harmful, patients and doctors can still decide not to treat," Hardesty said. "In either case, it's good to know." 

The findings were published in the Journal of the American College of Radiology.

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