Psychiatric morbidity associated with screening for breast cancer

Abstract

Summary The 28-item GHQ was used to assess psychiatric morbidity in 302 women attending for routine breast cancer screening, 300 women attending for further investigation of a positive screening result and 150 women referred for investigation of breast symptoms. The GHQ-28 was administered on arrival at the relevant clinic and three months later. Medical records were used to determine the outcome of the clinic attendance. Women were classified into routinely screened women, women with false positive screening results, symptomatic women with a benign diagnosis, newly diagnosed cancer patients and previously treated cancer patients. When tested on arrival at the clinic, 25% of routinely screened, 30% of women with false positive results and 35% of symptomatic women with benign conditions were probable cases of psychiatric morbidity. The only statistically significant difference was between the routinely screened and symptomatic benign groups. Levels of anxiety were significantly higher in those with false positive results and in the symptomatic benign group than in the routinely screened. Three months later the prevalence of probable psychiatric morbidity had fallen to 19% in both the routinely screened and those with false positive results but remained significantly higher in the symptomatic benign group (31%). Probable cases of psychiatric morbidity among newly detected cancer patients rose from 34 to 46% over the 3-month period. Among women who had had breast cancer diagnosed in the past prevalence remained at 21 %. The prevalence of probable psychiatric morbidity in screened women is similar to that in the general population. Among women referred for further investigation because of a false positive screening result prevalence was only slightly increased and there was no evidence of a sustained increase in anxiety. Provided that delays are kept to a minimum and that women are kept informed, a breast cancer screening programme does not increase psychiatric morbidity. Further research is required in cancer patients to determine whether those diagnosed in asymptomatic women have a higher and more sustained degree of psychiatric morbidity than those diagnosed in women who are aware of symptoms.Concern has been expressed that screening for breast cancer may have adverse psychological effects. The invitation for screening may make women more aware of their vulnerability and hence increase anxiety. Recalling women who are found to have an abnormality on screening for further investigation (currently 5-10% of those screened in the UK) may cause distress which is hard to alleviate even when further investigations are negative. Those who are symptom-free on screening but are found to have cancer could find it especially hard to adapt to the diagnosis (Maguire, 1982).The first concern has been partially investigated in Edinburgh (Dean et al., 1986). It was found that women attending for screening had no excess psychiatric morbidity compared to other women in the same age-group, (although little is yet known about morbidi...

Quality of life following a false positive mammogram

“…In order to justify the continued use of a screening procedure, subjects correctly classified as positive at screening should receive a benefit. However, the magnitude of the reduction in breast cancer resulting from screening has been questioned, and issues regarding adverse effects of breast screening have been raised (Skrabanak, 1985(Skrabanak, , 1988Wright, 1986;Eddy, 1988;Devitt, 1989 (Gram et al, 1989). Fourteen women were ineligible for the present study (two lost to migration before work-up, ten with a new and two with a previous diagnosis of breast cancer).…”

“…Altogether 40 (1 %) women underwent biopsy, mostly as hospital inpatients, and ten new cases of breast cancer were diagnosed. Details of the screening and case finding procedures are given elsewhere (Gram et al, 1989). Fourteen women were ineligible for the present study (two lost to migration before work-up, ten with a new and two with a previous diagnosis of breast cancer).…”

“…So far, breast screening has not been found to increase psychiatric morbidity as measured by the General Health Questionnaire, neither among women with negative (Dean et al, 1986) nor false positive screening results (Ellman et al, 1989). In the Canadian National Breast Screening Study (Baines et al, 1990) 93% of the women, receiving either annual mammography or physical examinations for three or four years, reported this as a positive experience.…”

The measurement of psychological distress in men being investigated for the presence of prostate cancer

“…There is a high incidence of psychiatric disturbance reported in women who were recently diagnosed with breast cancer. 1 There have been conflicting reports however, with regard to the prevalence of mental health disturbance in men being investigated and treated for prostate cancer; with some studies reporting a high (50-64%) prevalence of anxiety, 2,3 whereas others report low levels in men being investigated 4 or treated for early localized prostate cancer 5 that are no different from those of a matched normal population. In addition, other reports suggest that men with advanced prostate cancer had significantly greater psychological distress as compared to those with early stage disease.…”

Advanced breast cancer and its prevention by screening

“…However, the impact of screening on the prevention of advanced disease and its morbidity is generally neglected. In contrast to the research in costs and possible adverse effects of screening (Ellman et al, 1989) 1985-1989, (b) had received primary treatment with curative intent, (c) first diagnosis of breast cancer between the ages 50 and 80, were randomly taken. All 20 available female cases from the smaller hospital which met criteria (a) and (b) were used.…”