Psychosocial consequences of false-positive screening results - breast cancer as an example

1. 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

2. Content of presentation • Medical screening • Breast cancer screening • Psychosocial consequences • Conclusions and perspectives Psychosocial consequences of false-positive screening results - breast cancer as an example

3. Content of presentation • Medical screening • Breast cancer screening • Psychosocial consequences • Conclusions and perspectives Psychosocial consequences of false-positive screening results - breast cancer as an example

4. Screening the coal Psychosocial consequences of false-positive screening results - breast cancer as an example

5. Outcome of medical screening Psychosocial consequences of false-positive screening results - breast cancer as an example

6. Outcome of medical screening Psychosocial consequences of false-positive screening results - breast cancer as an example

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

8. Content of presentation • Medical screening • Breast cancer screening • Psychosocial consequences • Conclusions and perspectives Psychosocial consequences of false-positive screening results - breast cancer as an example

9. 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 example

10. Content of presentation • Medical screening • Breast cancer screening • Psychosocial consequences • Conclusions and perspectives Psychosocial consequences of false-positive screening results - breast cancer as an example

11. 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):39-44. 2004. Psychosocial consequences of false-positive screening results - breast cancer as an example

12. Focus groups - content validity J. Brodersen and H. Thorsen. Consequences Of Screening in Breast Cancer (COS-BC): development of a questionnaire. Scand.J Prim.Health Care 26 (4):251-256, 2008. Psychosocial consequences of false-positive screening results - breast cancer as an example

13. 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):251-256, 2008. Psychosocial consequences of false-positive screening results - breast cancer as an example

14. 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):294-304, 2007. Psychosocial consequences of false-positive screening results - breast cancer as an example

15. 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):294-304, 2007. Psychosocial consequences of false-positive screening results - breast cancer as an example

16. 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: 87-88638-36-7, 2006. Psychosocial consequences of false-positive screening results - breast cancer as an example

17. Scores of anxiety (0-18) 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):294-304, 2007. Psychosocial consequences of false-positive screening results - breast cancer as an example

18. 5 response category Psychosocial consequences of false-positive screening results - breast cancer as an example

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

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

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

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

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

24. Content of presentation • Medical screening • Breast cancer screening • Psychosocial consequences • Conclusions and perspectives Psychosocial consequences of false-positive screening results - breast cancer as an example

25. 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 example

26. 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 example

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

28. 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 example

29. 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 example

30. 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 example

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