Psychosocial consequences of false- positive screening results - breast cancer as an example John Brodersen MD, GP, PhD The Department of General Practice Institute of Public Health Centre of Health and Society University of Copenhagen

Psychosocial consequences of false-positive screening results - breast cancer as an example2 Content of presentation  Medical screening  Breast cancer screening  Psychosocial consequences  Conclusions and perspectives

Psychosocial consequences of false-positive screening results - breast cancer as an example3 Content of presentation  Medical screening  Breast cancer screening  Psychosocial consequences  Conclusions and perspectives

Psychosocial consequences of false-positive screening results - breast cancer as an example4 Screening the coal

Psychosocial consequences of false-positive screening results - breast cancer as an example5 Outcome of medical screening

Psychosocial consequences of false-positive screening results - breast cancer as an example6 Outcome of medical screening

Psychosocial consequences of false-positive screening results - breast cancer as an example7 Outcome of medical screening Healthy Disease Arbitrary scale

Psychosocial consequences of false-positive screening results - breast cancer as an example8 Content of presentation  Medical screening  Breast cancer screening  Psychosocial consequences  Conclusions and perspectives

Psychosocial consequences of false-positive screening results - breast cancer as an example9 Proportion  2,000 women, age 50 – 69, screened every second year for 10 years – 5 rounds: 1 death of breast cancer prevented > 200 false-positive result 1:200 P. C. Gotzsche and M. Nielsen. Screening for breast cancer with mammography. Cochrane Database.Syst.Rev. (4):CD001877, 2006.

Psychosocial consequences of false-positive screening results - breast cancer as an example10 Content of presentation  Medical screening  Breast cancer screening  Psychosocial consequences  Conclusions and perspectives

Psychosocial consequences of false-positive screening results - breast cancer as an example11 Adequacy of measurement  23 studies identified  Most commonly used measures: The General Health Questionnaire (GHQ) The Hospital Anxiety and Depression Scale (HADS) The Psychological Consequences Questionnaire (PCQ) The State-Trait Anxiety Inventory (STAI)  These 4 measures used in 17 studies Brodersen J., Thorsen H., Cockburn J. The adequacy of measurement of short and long term consequences of false-positive screening mammography. Review. Journal of Medical Screening 11 (1):

Psychosocial consequences of false-positive screening results - breast cancer as an example12 Focus groups - content validity ExaminationsUltrasound & clini-cal mammography Plus needle biopsy Plus surgical biopsy No. of women577 Mean age ExaminationsPlus early recall Plus needle biopsy Plus surgical biopsy No. of women557 Mean age J. Brodersen and H. Thorsen. Consequences Of Screening in Breast Cancer (COS-BC): development of a questionnaire. Scand.J Prim.Health Care 26 (4): , 2008.

Psychosocial consequences of false-positive screening results - breast cancer as an example13 Result from interviews  Part I: 33 items on negative psychosocial consequences At invitation At screening After diagnosis  Part II: 13 items on long-term psychosocial consequences After diagnosis J. Brodersen and H. Thorsen. Consequences Of Screening in Breast Cancer (COS-BC): development of a questionnaire. Scand.J Prim.Health Care 26 (4): , 2008.

Psychosocial consequences of false-positive screening results - breast cancer as an example14 Statistical methods  Reliability Cronbach’s alpha Person Separation Index Test-retest (part II)  Validity Rasch analysis Confirmatory factor analysis Concurrent validity Know group validity J. Brodersen, H. Thorsen, and S. Kreiner. Validation of a condition-specific measure for women having an abnormal screening mammography. Value in Health 10 (4): , 2007.

Psychosocial consequences of false-positive screening results - breast cancer as an example15 COS-BC part I  Psychosocial consequences of false positive screening results Anxiety – 6 items Behavioural aspects - 7 items Sense of dejection – 6 items Sleep problems - 4 items Breast examination - 2 items Sexuality - 2 items Single items – 3 items J. Brodersen, H. Thorsen, and S. Kreiner. Validation of a condition-specific measure for women having an abnormal screening mammography. Value in Health 10 (4): , 2007.

Psychosocial consequences of false-positive screening results - breast cancer as an example16 COS-BC part II  Psychosocial consequences of false positive screening results Anxious about/belief in (not) having breast cancer – 2 items More or less relax - 2 items Social relationship – 3 items Existential values - 6 items J. Brodersen. Measuring psychosocial consequences of false-positive screening results - breast cancer as an example, Department of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen:Månedsskrift for Praktisk Lægegerning, Copenhagen. ISBN: , 2006.

Psychosocial consequences of false-positive screening results - breast cancer as an example17 Scores of anxiety (0-18) GroupMean score Abnormal screening6.39 Breast cancer7.38 False-positive3.04 Undiagnosed4.38 Normal screening0.97 J. Brodersen, H. Thorsen, and S. Kreiner. Validation of a condition-specific measure for women having an abnormal screening mammography. Value in Health 10 (4): , 2007.

Psychosocial consequences of false-positive screening results - breast cancer as an example18 5 response category After the examinations I have thought about the broader aspects of life:  Much lessLessThe same as beforeMoreMuch more Fewer thoughts about life More thoughts about life

Psychosocial consequences of false-positive screening results - breast cancer as an example19 Know group validity - 1

Psychosocial consequences of false-positive screening results - breast cancer as an example20 Know group validity - 2

Psychosocial consequences of false-positive screening results - breast cancer as an example21 Know group validity - 3

Psychosocial consequences of false-positive screening results - breast cancer as an example22 Know group validity - 4

Psychosocial consequences of false-positive screening results - breast cancer as an example23 Know group validity - 4

Psychosocial consequences of false-positive screening results - breast cancer as an example24 Content of presentation  Medical screening  Breast cancer screening  Psychosocial consequences  Conclusions and perspectives

Psychosocial consequences of false-positive screening results - breast cancer as an example25 Conclusion 1  The conclusions drawn from previously conducted studies regarding long-term psychosocial consequences of false-positive screening mammography should remain tentative

Psychosocial consequences of false-positive screening results - breast cancer as an example26 Conclusion 2a  A valid and reliable condition- specific instrument measuring psychosocial consequences of abnormal and false-positive screening mammography has been established

Psychosocial consequences of false-positive screening results - breast cancer as an example27 Conclusion 2b  Consequences of Screening on Breast Cancer (COS-BC) 1. Psychosocial consequences of abnormal and false-positive screening mammography 2. Long-term psychosocial consequences of false-positive screening mammography

Psychosocial consequences of false-positive screening results - breast cancer as an example28 Conclusion 3  There are substantial negative psychosocial consequences associated with having an abnormal screening mammography later confirmed to be false-positive

Psychosocial consequences of false-positive screening results - breast cancer as an example29 Implications for practice  Letters and folders posted at invitation to screening should contain information on the negative psychosocial consequences arising from abnormal and false-positive screening results

Psychosocial consequences of false-positive screening results - breast cancer as an example30 Implications for research  Need for valid instruments in the area of psychosocial consequences of screening for any cancers  To establish core-items and core-subscales relevant for any kind of cancer screening

Psychosocial consequences of false-positive screening results - breast cancer as an example31 Consequences Of Screening Lung cancer P1: 17 items P2: 4 items Cervical cancer P1: 40 items Breast cancer P1: 4 items Core P1: 26 items P2: 22 items