Early detection of breast cancer through mammography saves lives, yet the screening journey can be fraught with emotional and psychological hurdles. One of the most notable challenges comes from false-positive results, where an abnormal finding on a mammogram leads to additional imaging or biopsies, only to reveal that no cancer is present. While this outcome may seem like a relief, new research highlights that it can have unintended consequences.
According to a study published in Annals of Internal Medicine, women who experience a false-positive mammogram are significantly less likely to return for future screenings. This drop in compliance raises a serious public health concern. We can leverage common sense, human-centered design ideas to help ameliorate this problem. By redesigning how healthcare systems communicate and manage follow-up after false-positive mammograms, we can mitigate the negative emotional impacts and increase adherence to essential breast cancer screenings.
The emotional toll of false positives
Mammograms, while invaluable for early detection, are not infallible. False positives occur in 10-12% of mammograms for women aged 40-49, and over a decade of screening, 50-60% of women will experience at least one. These false positives can lead to additional tests, some of which are invasive, like biopsies. Naturally, the prospect of a breast cancer diagnosis is terrifying, and while most additional tests confirm no malignancy, the process understandably leaves many women and their families anxious and emotionally drained.
The UC Davis study revealed that while 77% of women with a negative mammogram result returned for subsequent rescreening, only 61% of women returned for follow-up mammography after receiving a false-positive result. The numbers were even lower for women who received consecutive false positives, with just 56% returning for their next screening. These statistics are concerning because regular mammography is vital for early detection, especially in women at increased risk. The challenge becomes clear: how do we alleviate the anxiety and prevent disengagement from future screenings?
The promise of human-centered design
Human-centered design (HCD) offers a potential solution by emphasizing the needs and behaviors of patients. Rather than focusing solely on the technical aspects of healthcare, HCD puts the individual at the center of every decision, seeking to understand and solve problems from the user’s perspective. In this case, the “user” is a person navigating the emotionally charged world of mammograms and potential breast cancer diagnoses.
HCD focuses on three key principles that can be applied to improve follow-up mammography rates after false positives: empathy, clear communication, and co-design with patients.
Empathy: acknowledging the patient experience
Empathy is a cornerstone of human-centered design. In the context of mammography, it means recognizing and validating the fear and anxiety that a false-positive result can generate. It’s not enough to simply inform patients that no cancer was found. As clinicians, we must acknowledge the emotional journey that patients go through during the waiting period for results, especially when additional imaging or biopsies are required.
Practical empathy can take the form of pre-screening education that prepares women for the possibility of a false positive. Explaining up front that additional imaging or a biopsy doesn’t necessarily mean cancer can reduce some of the fear associated with follow-up tests. Some facilities already offer same-day diagnostic workups for abnormal findings, allowing women to receive immediate answers rather than waiting days or weeks in fear. Expanding this practice could significantly alleviate anxiety and make women more willing to return for future screenings.
Clear communication: bridging the gap between clinicians and patients
One of the most significant barriers to adherence after a false positive result is unclear or confusing communication. Many women don’t fully understand what a false positive means and some may interpret additional testing as an indicator that something is seriously wrong, even after receiving a negative result. Human-centered design encourages the use of clear, compassionate communication.
Clinicians should explain the likelihood of a false-positive result in simple terms, using visual aids if necessary. Additionally, it’s crucial to frame follow-up testing as a routine part of the screening process rather than something out of the ordinary. Healthcare providers could also use patient-friendly apps to deliver results, explanations, and reassurance in an accessible format, allowing patients to communicate directly with their providers if they have concerns.
For non-English-speaking women or those from underserved communities, language and cultural barriers further complicate communication. The UC Davis study found that Asian and Hispanic/Latinx women were the least likely to return for follow-up screenings after a false-positive result. This disparity highlights the need for culturally competent communication, tailored to the diverse population that mammography serves.
Co-design: involving patients in the solution
The most effective solutions are those designed with input from the people they are meant to serve. Human-centered design advocates for co-creation, where patients help shape the systems with which they interact. In this case, involving women who have experienced false positives in the redesign of follow-up protocols could provide valuable insights into what might make them more likely to return for future screenings.
For example, some patients might prefer more immediate access to their results, while others may prioritize having a more thorough explanation of what to expect after a false positive in conjunction with their primary care doctor. Co-design workshops with diverse groups of women could help identify the most effective strategies for improving follow-up rates. Moreover, healthcare systems should collect ongoing feedback from patients to continuously refine their processes.
Designing for better health outcomes
The emotional toll of a false-positive mammogram is significant, but it doesn’t have to derail future breast cancer screenings. By applying human-centered design principles – empathy, clear communication, and co-design – healthcare systems can improve the patient experience and increase adherence to follow-up mammography. As clinicians and healthcare leaders, we must design processes that recognize the emotional and psychological burden on patients and work to alleviate it, ultimately leading to earlier detection, better outcomes, and saved lives.