Heleno Bruno, Siersma Volkert Dirk, Brodersen John
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Ann Fam Med. 2015 May-Jun;13(3):242-9. doi: 10.1370/afm.1762.
We undertook a study to assess whether women with false-positive mammography have worse psychosocial consequences if managed with a workup that involves a biopsy (invasive group) than if managed with only additional imaging (noninvasive group).
We performed subgroup analysis of a cohort study of 454 women with abnormal screening mammography and 908 matched control women with normal results. Using a condition-specific questionnaire (Consequences of Screening in Breast Cancer), we assessed 12 psychosocial consequences at 5 time points (0, 1, 6, 18, and 36 months after final diagnosis) and compared the 2 groups of women with false-positives (invasive and noninvasive management groups).
Among the 252 women with false-positive mammography eligible for this study, psychosocial consequences were similar for those managed invasively and those managed noninvasively during the 36 months of follow-up. In 60 comparisons (12 scales and 5 time points), differences between the groups were never statistically significant (P <.01) and the point estimates for the differences were always close to zero. The psychosocial consequences of women with false-positive results, regardless of management, fell between those of women with normal mammography and those of women determined to have breast cancer.
We found no evidence that use of more invasive diagnostics was associated with worse psychosocial consequences. It is therefore reasonable to pool subgroups of women with false-positives in a single analysis. The invasiveness of subsequent diagnostic procedures does not help to identify women at higher risk for adverse psychosocial consequences of false-positive mammography.
我们开展了一项研究，以评估乳腺钼靶检查结果为假阳性的女性，若采用涉及活检的检查流程（侵入性组）进行处理，与仅采用额外影像学检查（非侵入性组）进行处理相比，是否会产生更严重的心理社会后果。
我们对一项队列研究进行了亚组分析，该队列研究包括454名乳腺钼靶筛查结果异常的女性和908名匹配的检查结果正常的对照女性。我们使用特定疾病问卷（乳腺癌筛查的后果），在5个时间点（最终诊断后的0、1、6、18和36个月）评估了12种心理社会后果，并比较了两组假阳性女性（侵入性和非侵入性处理组）。
在本研究纳入的252名乳腺钼靶检查结果为假阳性的女性中，在36个月的随访期间，侵入性处理组和非侵入性处理组的心理社会后果相似。在60次比较（12个量表和5个时间点）中，两组之间的差异均无统计学意义（P<.01），差异的点估计值始终接近零。无论采用何种处理方式，假阳性结果女性的心理社会后果介于乳腺钼靶检查结果正常的女性和确诊患有乳腺癌的女性之间。
我们没有发现证据表明采用更具侵入性的诊断方法会导致更严重的心理社会后果。因此，在单一分析中合并假阳性女性亚组是合理的。后续诊断程序的侵入性无助于识别乳腺钼靶检查结果为假阳性时心理社会后果不良风险较高的女性。
