Consequences of False-Positive Mammogram Results

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In response to the Swiss Medical Board’s recommendations against women of any age getting routine mammograms, critics suggested that instead of phasing out screening programs completely, we should leave it up to each woman individually to make her own judgment, once she’s “fully informed” about the pros and cons. “On the basis of the same information, some women will choose screening, and others will not.” I agree—that’s why I’m doing this video series to lay out the benefits and the harms.

When it comes to medical treatments, I think most patients understand there are risks and benefits: drugs can have side effects; surgeries can have complications. So, you can make your decision based on whether you think the benefits outweigh the risks. But, “patients have been taught to think differently about screening.” What’s the harm? Who wouldn’t want to know if you have cancer? It’s a no-brainer. But, “[i]n reality, the truth is more nuanced. There are benefit and harms to consider in screening—just as there are in treatment.”

In the case of mammograms, “the most frequent harm is a false-positive result,” where they think they see something on the scan, but after further testing—more X-rays, ultrasound, or a biopsy—it turns out to be nothing. Phew. As you can imagine, this can cause a “roller coaster of emotions.” “Experiencing a false-positive result can [be an] agonising experience…,” sometimes “profoundly” affecting a woman’s life. Some women then can get depressed, anxious, and lose sleep over it, even months later. Even after getting the all clear, breast cancer worries can persist, even a year or more later. And, beyond psychological effects, if you have to go in for a biopsy, they obviously use local anesthesia during the procedure, but the pain afterwards can sometimes persist for days or weeks.

“These adverse consequences would be less concerning if false-positive mammograms were…uncommon event[s].” Unfortunately, most women will get “at least one false-positive mammogram within 10 years” of annual screening, though the chances that a single mammogram will produce a false positive is only about 10 to 14%.

But, that’s way more than over in Europe, for example, where it’s only like one in 20, or one in 50. That’s thought to be because American radiologists are so afraid of being sued for malpractice that the bar they use is much lower. And, that’s fine for a lot of women. Even if 10,000 women have to go through false positives, many feel it would be worth it to save a life—even many women who have themselves experienced a false-positive result firsthand, so they know what it’s like. Most women don’t even “want to take false positives into account when deciding about screening,” but some women do.

For some, going through a false alarm is no big deal, but for others, it can be really scary. Some women interviewed going through the process were described as being in a state of “[e]motional chaos” facing a possible cancer diagnosis. “Waiting for [the] results” was particularly hard for some women; it was constantly on their minds. But after it was over, many women were able to just brush it off, whereas others had persistent anxiety, even though they were given the all clear.

Studies have noted increased anxiety, on average, even months later, after being called back for a suspicious mammogram that turned out to be nothing. Or, even years later. A study of hundreds of women who experienced a false positive, and some appeared to be suffering the consequences— even years later. They were followed out for three years, and the experience still seemed to haunt them. So, maybe we shouldn’t just dismiss these false alarms.

Regardless, “women should be informed of the [possibility], and reassured that most women who are recalled” back for further testing of a suspicious mammogram finding “do not end up having cancer” after all, so as to put their mind at ease a bit as they go through the process, and wait for the final results.

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Image credit: Bill Branson via Wikimedia. Image has been modified.

Motion graphics by Avocado Video

• anxiety
• breast cancer
• breast cancer survival
• cancer
• depression
• mammograms
• mental health
• side effects
• stress
• women's health