Intervention combats anxiety prior to breast cancer screening

Research published recently in the Journal of the American College of Radiology has detailed a successful intervention to reduce anxiety induced by false-positive mammography results.

The intervention has important implications for reducing the barriers to screening and also for deciding who should be screened. This research comes following recent breast cancer screening guidelines from the American Cancer Society, which have considered anxiety to be an “important but not critical outcome” for screening decisions.

Within the study, participants from a group of business, religious and community organizations in New York undertook a questionnaire before attending an informal lunchtime lecture from Jiyon Lee of the New York University School of Medicine Department of Radiology (NY, USA). This talk discussed the logistics and outcomes of mammography screening.

Following the talk, the 117 attendees scored a mean of 4 on a scale from 1–5 describing decreased screening anxiety.

The questionnaire also discovered sources of screening anxiety: 56 % worried about unknown results; 22% anticipated pain; 15% worried about how known risk factors may influence the likelihood of a breast cancer diagnosis; 13% cited general uncertainty; 9% were anxious about waiting for results; and 4% were concerned about the possibility of additional procedures.

Lara Hardesty, Investigator at the University of Colorado Cancer Center (CO, USA) commented: “Our question was, if the American Cancer Society – and before them the US Preventative Task Force – considered anxiety a harm that could prevent screening, how could we minimize that harm?”

The team hypothesized that information would reduce anxiety. Within the 1 hour talk, Lee aimed to teach women on what to expect during and following mammograms and inform women on how positive screening results do not definitively indicate cancer.

After the session, a follow-up questionnaire revealed that nearly all attendees were able to correctly answer questions on the rationale for screening, the difference between the need for additional testing and a cancer diagnosis, the benefit of negative screenings as a baseline for future comparisons, and the continued importance of physical examinations.

Overall, lectures were associated with gains in understanding of 4.7 on a 1–5 scale, 4.6 of encouragement to screen and 4 for reduced anxiety.

Hardesty believes that there is a major difference between the concepts of overdiagnosing and overtreating breast cancer. Interventions such as this one could reduce anxiety barriers and encourage screening of breast cancer– a necessity for enabling early diagnosis.

Sources: Lee J, Hardesty LA, Kunzler NM , Rosencrantz AB. Direct interactive public education by breast radiologists about screening mammography: impact on anxiety and empowerment. J. Am. Coll. Radiol. doi: 10.1016/j.jacr.2015.07.018 (2015); University of Colorado Cancer Center press release