DECREASING ADVERSE EFFECTS OF FALSE POSITIVE MAMMOGRAMS

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DESCRIPTION: False-positive mammogram readings, which account for more than 10 percent of all screening mammograms, cause long-lasting anxiety in women and are associated with low adherence to subsequent screening mammogram recommendations. The investigators propose a study to evaluate two strategies to reduce adverse psychosocial effects of false-positive mammograms in community women members of a large health maintenance organization in a Northeast urban area. A psychoeducational intervention, consisting of a videotape presentation and a pamphlet to explain the concept of a false-positive mammogram reading and how to cope with it will be developed and given to women at the time of their screening mammograms in eight radiology practices. It will be evaluated, along with a radiology system intervention to provide on-site readings and immediate follow-up investigations to women with abnormal readings. A factorial design, with four study groups will be used: Control, Education, Immediate Follow-up, and Both. Levels of anxiety and concern about breast cancer and mammography, adherence to subsequent screening mammography, health-care utilization in the 12 months after screening mammography, and daily functioning will be assessed in the women in each group, by telephone interviews at two weeks and three months after the screening mammogram, and by medical record review. Differences among the four groups will be sought, using the Impact of Event Scale and the Hopkins Symptom Checklist for levels of anxiety, and short-form General Health Survey for daily function. Psychological effects will be plotted over time, and effect modifiers will be sought to determine if the interventions affect women differentially. Feasibility and cost of both interventions will be determined and cost-effectiveness analyses will be performed. Because of high levels of anxiety about breast cancer and breast cancer screening among women in general, in a secondary study, the investigators will determine the same set of outcomes in two groups of women with normal mammogram readings: Control and Education. The study will determine whether simple strategies alleviate adverse psychosocial effects of an important breast cancer screening procedure that more than 25 million American women receive each year.