Longitudinal study of the influence of false-positive mammography results on psychological outcomes and subsequent screening behavior

If screened regularly, over one-half of U.S. women will have abnormal mammography results that require additional follow-up but in which cancer is not detected (false-positive result). This dissertation presents and tests a model, informed by theoretical and empirical evidence, of the relationship between receipt of false-positive mammography results and adherence to subsequent mammography screening. To test study hypotheses, I analyzed longitudinal data (n=2406), gathered through medical claims records and telephone interviews, as part of the PRISM (Personally Relevant Information on Screening Mammography) intervention trial to increase repeat mammography adherence among insured North Carolina women. About 8% of women received false-positive mammography results within 14 months of their interviews. Among women who said their physicians had not advised them to get mammograms in the past year, those who received false-positive results were more likely to have no subsequent mammogram on record compared to women whose results were normal (18% vs. 7%, OR=3.17, 95% CI=1.30,7.71). However, among women who reported physician recommendations, receipt of false-positive results was not associated with adherence to subsequent screening. Receipt of false-positive results was associated with greater breast cancer worry (p<.001), the belief that mammography test results were less accurate (p=.003), and thinking more about the benefits of regular screening (p<.001), regardless of physician recommendations. In mediation analyses, none of these variables explained the association between false-positive test results and subsequent screening behavior. Findings suggest that women who receive false-positive mammography results, coupled with lack of physician recommendations for screening, are at risk for non-adherence to future screening. Abnormal mammograms that do not result in a cancer diagnosis are opportunities for physicians to emphasize the importance of regular screening. Findings provided only partial support for the proposed model, perhaps due to characteristics of the PRISM study design, where all women received annual reminders for their mammograms and received mammograms prior to study enrollment

Anticipated regret and health behavior: A meta-analysis.

Risk beliefs are central to most theories of health behavior, yet many unanswered questions remain about an increasingly studied risk construct, anticipated regret. We sought to better understand anticipated regret’s role in motivating health behaviors

A model of the influence of false-positive mammography screening results on subsequent screening

Decades of empirical research have demonstrated psychological and behavioural consequences of false-positive medical tests. To organise this literature and offer novel predictions, we propose a model of how false-positive mammography results affect return for subsequent mammography screening. We propose that false-positive mammography results alter how women think about themselves (e.g., increasing their perceived likelihood of getting breast cancer) and the screening test (e.g., believing mammography test results are less accurate). We further hypothesise that thoughts elicited by the false-positive experience will, in turn, affect future use of screening mammography. In addition, we discuss methodological considerations for statistical analyses of these mediational pathways and propose two classes of potential moderators. While our model focuses on mammography screening, it may be applicable to psychological and behavioural responses to other screening tests. The model is especially timely as false-positive medical test results are increasingly common, due to efforts to increase uptake of cancer screening, new technologies that improve existing tests’ ability to detect disease at the cost of increased false alarms, and growing numbers of new medical tests

Understanding how breast cancer patients use risk information from genomic tests

We sought to examine how patients’ treatment decisions incorporate potentially conflicting information from standard clinical indicators (e.g., tumor size) and genomic tests for breast cancer recurrence risk

The Harms of Screening: A Proposed Taxonomy and Application to Lung Cancer Screening

IMPORTANCE Making rational decisions about screening requires information about its harms, but high-quality evidence is often either not available or not used. One reason may be that we lack a coherent framework, a taxonomy, for conceptualizing and studying these harms. OBJECTIVE To create a taxonomy, we categorized harms from several sources: systematic reviews of screening, other published literature, and informal discussions with clinicians and patients. We used this information to develop an initial taxonomy and vetted it with local and national experts, making revisions as needed. RESULTS We propose a taxonomy with 4 domains of harm from screening: physical effects, psychological effects, financial strain, and opportunity costs. Harms can occur at any step of the screening cascade. We provide definitions for each harm domain and illustrate the taxonomy using the example of screening for lung cancer. CONCLUSIONS AND RELEVANCE The taxonomy provides a systematic way to conceptualize harms as experienced by patients. As shown in the lung cancer screening example, the taxonomy also makes clear where (which domains of harms and which parts of the screening cascade) we have useful information and where there are gaps in our knowledge. The taxonomy needs further testing and validation across a broad range of screening programs. We hope that further development of this taxonomy can improve our thinking about the harms of screening, thus informing our research, policy making, and decision making with patients about the wisdom of screening

Improving communication of breast cancer recurrence risk

Doctors commonly use genomic testing for breast cancer recurrence risk. We sought to assess whether the standard genomic report provided to doctors is a good approach for communicating results to patients

Impact of Mailed and Automated Telephone Reminders on Receipt of Repeat Mammograms. A Randomized Controlled Trial

This study compares the efficacy of three types of reminders in promoting annual repeat mammography screening

Influence of false-positive mammography results on subsequent screening: do physician recommendations buffer negative effects?

Cancer screening guidelines often include discussion about the unintended negative consequences of routine screening. This prospective study examined effects of false-positive mammography results on women’s adherence to subsequent breast cancer screening and psychological well-being. We also assessed whether barriers to screening exacerbated the effects of false-positive results

Factors associated with annual-interval mammography for women in their 40s

Evidence is mounting that annual mammography for women in their 40s may be the optimal schedule to reduce morbidity and mortality from breast cancer. Few studies have assessed predictors of repeat mammography on an annual interval among these women