Barton Mary B, Morley Debra S, Moore Sara, Allen Jennifer D, Kleinman Ken P, Emmons Karen M, Fletcher Suzanne W
Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA 02215, USA.
J Natl Cancer Inst. 2004 Apr 7;96(7):529-38. doi: 10.1093/jnci/djh083.
Few studies have evaluated interventions to decrease a woman's anxiety after she receives an abnormal mammogram (i.e., one with a recommendation for follow-up). We performed a controlled trial to compare the effects of both an immediate reading of mammograms (i.e., a radiology intervention) and of an educational intervention that taught skills to cope with anxiety on the psychological status of women whose mammograms were normal or abnormal.
Eligible women (n = 8543) aged 39 years or older were recruited from seven mammography sites at the time of their scheduled mammography screening and assigned to receive no intervention, either the radiology or the educational intervention, or both interventions. We used the Impact of Events Scale (IES) and the Hopkins Symptom Checklist subscales for Anxiety (HSC-A) and Depression (HSC-D) in structured telephone interviews of 2844 women to assess the psychological status of all women with abnormal mammograms (excluding women diagnosed with breast cancer) and of a random sample of women with normal mammograms at 3 weeks and 3 months after their mammograms. All statistical tests were two-sided.
We obtained usable 3-week interviews for 2390 (84%) women. By the 3-week interview, 1037 (72.1%) of the 1439 interviewed women with abnormal mammograms had completed the recommended work-up and knew that their abnormal mammograms were false positives. Women with abnormal mammograms had higher IES and HSC-A scores (i.e., more anxiety) than women with normal mammograms (mean IES scores: 4.97 [95% confidence interval [CI] = 4.47 to 5.50] and 1.82 [95% CI = 1.51 to 2.14], respectively; P<.001; mean HSC-A scores: 1.14 [95% CI = 1.12 to 1.15] and 1.11 [95% CI = 1.09 to 1.13], respectively, P=.002). Among women with false-positive mammograms, those who had received the radiology intervention reported less anxiety than those who had not (mean IES scores: 4.42 [95% CI = 3.73 to 5.07] and 5.53 [95% CI = 4.82 to 6.28], respectively, P=.026). The educational intervention was not associated with any difference in psychological outcomes. Three months after the mammogram, by which time more than 80% of the women with abnormal results knew their mammograms to be false positives, anxiety levels of women with false-positive mammograms remained higher than those of women with normal mammograms (mean IES scores: 2.34 [95% CI = 1.99 to 2.69] and 1.15 [95% CI = 0.87 to 1.47], respectively, P<.001).
Immediate reading of screening mammograms, but not an educational intervention targeting coping skills, was associated with less anxiety among women with false-positive mammograms 3 weeks after mammography.
很少有研究评估在女性收到异常乳房X光检查结果（即建议进行随访的结果）后，减轻其焦虑的干预措施。我们进行了一项对照试验，比较乳房X光检查结果即时解读（即一种放射学干预措施）和一项教授应对焦虑技巧的教育干预措施，对乳房X光检查结果正常或异常的女性心理状态的影响。
年龄在39岁及以上的符合条件的女性（n = 8543）在其预定的乳房X光检查筛查时，从七个乳房X光检查站点招募，并被分配接受不干预、放射学干预、教育干预或两种干预措施。我们在对2844名女性进行的结构化电话访谈中，使用事件影响量表（IES）以及霍普金斯症状清单焦虑分量表（HSC - A）和抑郁分量表（HSC - D），以评估所有乳房X光检查结果异常的女性（不包括被诊断为乳腺癌的女性）以及乳房X光检查结果正常的女性随机样本在乳房X光检查后3周和3个月时的心理状态。所有统计检验均为双侧检验。
我们获得了2390名（84%）女性的可用3周访谈数据。到3周访谈时，1439名接受访谈的乳房X光检查结果异常的女性中有1037名（72.1%）完成了推荐的检查，并知道她们的异常乳房X光检查结果为假阳性。乳房X光检查结果异常的女性比乳房X光检查结果正常的女性有更高的IES和HSC - A分数（即更多焦虑）（平均IES分数分别为：4.97 [95%置信区间[CI] = 4.47至5.50]和1.82 [95% CI = 1.51至2.14]，P <.001；平均HSC - A分数分别为：1.14 [95% CI = 1.12至1.15]和1.11 [95% CI = 1.09至1.13]，P =.002）。在乳房X光检查结果为假阳性的女性中，接受放射学干预的女性报告的焦虑程度低于未接受干预的女性（平均IES分数分别为：4.42 [95% CI = 3.73至5.07]和5.53 [95% CI = 4.82至6.28]，P =.026）。教育干预与心理结果的任何差异均无关联。乳房X光检查后3个月，此时超过80%的检查结果异常的女性知道她们的乳房X光检查结果为假阳性，但乳房X光检查结果为假阳性的女性的焦虑水平仍高于乳房X光检查结果正常的女性（平均IES分数分别为：2.34 [95% CI = 1.99至2.69]和1.15 [95% CI = 0.87至1.47]，P <.001）。
乳房X光检查结果即时解读，而非针对应对技巧的教育干预，与乳房X光检查后3周乳房X光检查结果为假阳性的女性焦虑程度较低有关。
