Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Ann Fam Med. 2013 Mar-Apr;11(2):106-15. doi: 10.1370/afm.1466.
Cancer screening programs have the potential of intended beneficial effects, but they also inevitably have unintended harmful effects. In the case of screening mammography, the most frequent harm is a false-positive result. Prior efforts to measure their psychosocial consequences have been limited by short-term follow-up, the use of generic survey instruments, and the lack of a relevant benchmark-women with breast cancer.
In this cohort study with a 3-year follow-up, we recruited 454 women with abnormal findings in screening mammography over a 1-year period. For each woman with an abnormal finding on a screening mammogram (false and true positives), we recruited another 2 women with normal screening results who were screened the same day at the same clinic. These participants were asked to complete the Consequences of Screening in Breast Cancer-a validated questionnaire encompassing 12 psychosocial outcomes-at baseline, 1, 6, 18, and 36 months.
Six months after final diagnosis, women with false-positive findings reported changes in existential values and inner calmness as great as those reported by women with a diagnosis of breast cancer (Δ = 1.15; P = .015; and Δ = 0.13; P = .423, respectively). Three years after being declared free of cancer, women with false-positive results consistently reported greater negative psychosocial consequences compared with women who had normal findings in all 12 psychosocial outcomes (Δ >0 for 12 of 12 outcomes; P <.01 for 4 of 12 outcomes).
False-positive findings on screening mammography causes long-term psychosocial harm: 3 years after a false-positive finding, women experience psychosocial consequences that range between those experienced by women with a normal mammogram and those with a diagnosis of breast cancer.
癌症筛查项目具有预期的有益效果，但也不可避免地存在意外的有害影响。在乳腺 X 线筛查的情况下，最常见的危害是假阳性结果。以前衡量其心理社会后果的努力受到短期随访、使用通用调查工具以及缺乏相关基准（乳腺癌患者）的限制。
在这项为期 3 年的队列研究中，我们在 1 年内招募了 454 名在筛查性乳腺 X 线摄影中出现异常结果的女性。对于每一位在筛查性乳腺 X 线摄影中出现异常结果（假阳性和真阳性）的女性，我们招募了另外 2 位在同一天同一诊所接受筛查的结果正常的女性。这些参与者被要求在基线、1、6、18 和 36 个月时完成《乳腺癌筛查后果》调查问卷，这是一个包含 12 个心理社会结果的有效问卷。
在最终诊断后 6 个月，假阳性发现的女性报告的生存价值观和内心平静的变化与乳腺癌诊断的女性报告的变化一样大（Δ=1.15；P=0.015；和Δ=0.13；P=0.423）。在宣布无癌症 3 年后，与结果正常的女性相比，假阳性结果的女性在所有 12 个心理社会结果中持续报告了更大的负面心理社会后果（12 个结果中有 12 个的Δ>0；在 12 个结果中有 4 个的 P<0.01）。
乳腺 X 线筛查的假阳性结果会导致长期的心理社会伤害：在假阳性发现后 3 年，女性经历的心理社会后果介于正常乳腺 X 线摄影和乳腺癌诊断的女性之间。
