TUESDAY, April 6, 2004 (HealthDayNews) -- Women who learned the results of their mammograms on the spot experienced less anxiety than women who had to wait several days.
At the same time, educational materials consisting of a video and pamphlet did nothing to allay fears for those undergoing the routine breast cancer screenings, according to a new study appearing in the April 7 issue of the Journal of the National Cancer Institute.
"The results give some kind of backbone to the pressure to decrease patients' wait for tests results in general, but we've been moving in the opposite direction in our society," said Dr. Julia Smith, an oncologist at New York University Cancer Institute in New York City.
According to the study authors, some 5 to 11 percent of all screening mammograms show some kind of abnormality that requires a follow-up. Of these, 97 percent turn out to be "false positives," meaning they are not malignant.
One estimate has it that about half of all women will experience at least one false positive for every 10 screening mammograms they undergo.
Even if the final outcome is normal, having a mammogram is associated with a good deal of stress and anxiety.
For this study, 8,543 women undergoing an initial mammography were divided into four different groups. One group of women received a reading while they waited in the office (this way any follow-up tests could be done in the same visit); others were notified after several days; some received an educational pamphlet and video; others did not.
The educational materials provided coping strategies and key definitions, addressed concerns women might have, and explained the different reasons a mammogram could be abnormal.
"It was meant to normalize the experience," said Dr. Mary B. Barton, lead author of the study and an assistant professor of ambulatory care and prevention at Harvard Medical School in Boston.
Of the original group, 80 percent (6,801 women) had normal mammograms while 20 percent (1,742) had abnormal readings that later turned out to be false positives.
All the women with false positives and a sample of those with normal results were then followed up via telephone three weeks later and again three months later. The researchers also kept track of what kind of follow-up women were advised to have -- for example, another mammography in six months or a biopsy.
Three weeks after their mammograms, half the women who had had a false positive said they had feelings of anxiety compared with 28 percent of women who had had normal readings. Many of these anxious feelings persisted three months later for the women who had had false positives.
"Women who received the immediate reading who had had a false positive were less anxious three weeks later than women who had a delayed reading, even though almost everybody knew they were in the clear," Barton said.
After three months, anxiety levels had gone down but were still evident.
"By three months after the mammogram, everybody's anxiety levels were lower, but the women who had had false positive mammograms continued to have more anxiety even though well over 70 percent had had a conclusion," Barton said. "The folks who had had the immediate reading had lower anxiety levels than the folks who had had a standard reading, but it was no longer statistically significant."
The more severe the next recommended step, the more anxiety a woman tended to experience.
"What I thought was alarming regarding women who were recommended to have a six-month follow-up is that they were quite anxious at three weeks and at three months," Barton said. "Everybody has some alleviation with time, but women who were recommended to just sit tight and come back in six months weren't able to put it out of their minds."
And whatever the level of anxiety, it did not disappear quickly. "It's not just momentary and instantaneous. It doesn't go away after a day. There's a lingering aspect to it," Barton said. "The way that we structure the provision of health care can make a difference in how people feel."
But how realistic is it to expect while-you-wait service from a mammography facility?
A lot of it depends on location, according to Barton. "There are local variations in the supply of experts," she said.
Also, many mammography facilities are having trouble recruiting qualified mammographers because of what many perceive to be a malpractice crisis, she added. The facility in Boston where this study was conducted had already started a rapid-reply service on its own.
More information
For more on mammograms, visit the National Cancer Institute or the National Women's Health Information Center.
