False-positive cancer results push patients to keep up with annual screenings
False-positive results from a breast or prostate cancer exam could be driving affected men and women to adhere to clinical testing guidelines, researchers wrote in a Cancer study—though a handful of false-positive patients are actually deterred from future screenings.
They might not be ideal, but false-positive cancer readings are common, first author Glen B. Taksler, PhD, and colleagues wrote. Over the next decade, more than half of women will experience a false-positive during an annual mammogram, and up to 12 percent of men are expected to receive a false-positive after prostate-specific antigen (PSA) screening.
“False-positive cancer screening test results may affect an individual’s willingness to continue screening for cancer in the future,” Taksler et al. said. “Approximately 40 percent of women experiencing a false-positive mammogram labeled the experience as ‘very scary’ or the ‘scariest time in my life.’”
Still, the actual implications of false-positives are largely unknown, the authors wrote. Some studies, like a 2007 meta-analysis of U.S. women, found patients were 7 percent more likely to return for future screenings after a false-positive mammogram, while in that same study false-positives translated to a 37 percent drop in screening rates among Canadian women.
For their study, Taksler and his team evaluated 10 years of electronic medical record data to analyze the relationship between false-positives and future willingness to undergo cancer testing. The authors said that while it makes sense some patients would feel more urgency to stick to routine testing after a false-positive, it also makes sense that some lose faith in the process.
EMR data for the study came from 92,405 individuals who’d experienced a false-positive result after a breast, prostate or colorectal exam. Combined, the 50- to 75-year-olds comprised 450,484 person-years of records.
The team found that, barring women who received false-positives after PSA or colorectal testing—those patients were less likely to undergo future breast cancer screening—both men and women felt an increased urgency to engage in future testing.
“In general, those who were up-to-date with one cancer screening were more likely to obtain other screenings—an intuitive finding noted by others,” Taksler and colleagues wrote. “More interestingly, individuals who had experienced a prior false-positive breast or prostate cancer screening test result were much more likely to participate in future screenings compared with individuals who had not experienced a false-positive result.”
David C. Johnson, MD, MPH, and Joann G. Elmore, MD, MPH, said in an accompanying Cancer editorial that a patient’s course of behavior post-false-positive is likely dependent on a host of factors, including psychology, knowledge, societal perceptions of cancer and how that patient was notified about their false-positive. But, they said, the underlying takeaway from Taksler et al.’s study could be concerning.
“The finding that patients who experienced false-positive breast and prostate cancer screening tests had a greater likelihood of future guideline-recommended breast and colon cancer screening initially might appear reassuring,” Johnson and Elmore wrote. “However, if the increased participation in screening is due to fear and anxiety from the false-positive examination, this suggests a sustained psychological effect, which is troubling.”
The authors said clinicians need to sit down with patients prior to an exam and discuss, frankly, the probabilities of finding cancer.
“Uncertainty always exists to a certain degree, but we need to inform patients about the possibility and significance of a positive screening test and explain the positive predictive value,” they said. “Although it is easy to get too far down a rabbit hole with a worse-case scenario and overwhelm with hypotheticals, concisely stating the range of possible results and the next course of action for each may help to reduce anxiety.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.