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Tuesday, 19 October 2004

This presentation is part of: Poster Session - Clinical Strategies; Judgment and Decison Making

DO FALSE POSITIVE MAMMOGRAMS ADVERSELY AFFECT QUALITY OF LIFE? RESULTS FROM THE DMIST ACRIN TRIAL

ANA Tosteson, Dartmouth Medical School, Medicine and Community and Family Medicine, Lebanon, NH, DG Fryback, University of Wisconsin, Population Health Sciences and Industrial Engineering, Madison, WI, CS Hammond, Dartmouth Medical School, Community and Family Medicine, Lebanon, NH, LG Hanna, Brown University, ACRIN Biostatistics Center, Center for Biostatistical Science, Providence, RI, ME Brown, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Liverpool, NY, and ED Pisano, University of North Carolina at Chapel Hill, Radiology and Biomedical Engineering, Chapel Hill, NC.

Purpose: A substantial proportion of women who undergo routine screening mammography over a 10-year period will experience a false positive exam, requiring additional work-up to rule out breast cancer. Improved specificity for new breast screening modalities will result in fewer false positive exams. To value improved specificity in economic analyses, our objective was to characterize the impact of false positive mammograms on quality of life, anxiety and attitudes toward future mammography screening.

Methods: Digital Mammography Imaging Screening Trial (DMIST) participants were selected for a quality of life sub-study, with equal sampling of those with positive and negative mammograms. Telephone interviews were completed shortly after the initial screening mammogram and one-year later. At both time points women completed a short-form of the Spielberger stait-trait anxiety questionnaire (STAI6), EQ-5D, and a current health rating scale (RS). At follow-up, women reported attitudes toward future screening mammography and their willingness to travel to avoid a false positive exam.

Results: We report preliminary data for 1,024 (493 false positive and 531 negative exams) women ages 27 to 85 (mean age 53) who completed both interviews. Among those with false positive exams, the initial interview was conducted before work-up was complete for 222(48%). At baseline, women who required additional work-up had significantly higher anxiety compared to age-matched women who did not (STAI6 35.2 vs. 32.7), but had similar health state values (EQ-5D 0.877 vs. 0.882; RS 84.3 vs. 85.9). At one year, there were no significant differences in STAI6, EQ-5D, or RS between those with false positive and negative mammograms. Women with false positive exams were significantly more likely to report that they would undergo future routine screening than those with a negative exam (26% vs. 14%); however, they were no more willing to travel and stay overnight to avoid a false positive exam (80% vs. 86%).

Conclusion: Although false positive screening mammograms were associated with increased anxiety and women were willing to travel to avoid such exams, this did not measurably affect health state values measured by EQ-5D.


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