Psychological consequences of mammography screening recommendations: a prospective cohort study in Iran

Breast cancer is the most common malignancy among women. Despite advances in treatment, some women still present at advanced stages of the disease. Although mammography screening can improve survival through early detection, there is ongoing debate regarding its benefits and potential harms. This study aimed to investigate the psychological consequences of breast cancer screening and the factors associated with them.

This prospective cohort study was conducted in Iran and included 320 women aged 40-69 years who attended comprehensive health centers for gynecologic care and met the inclusion criteria. According to the eligibility criteria, women aged 35-69 years with a family history of breast cancer were also eligible; however, in practice, no participants younger than 40 years were enrolled. Participants were selected using convenience sampling, while health centers were chosen randomly. In total, ten centers from the northern and southern regions of the city were selected through simple random sampling by drawing lots. Participants were classified into two groups based on acceptance or refusal of mammography. Data were collected before and after the screening recommendation using a demographic and reproductive characteristics form and the Psychological Consequences Questionnaire (PCQ), which assesses emotional, social, and physical functioning. The reliability of the data collection tools was evaluated through a pilot study and calculation of Cronbach's alpha coefficients. Data were analyzed using SPSS version 18.

Before the screening recommendation, there was no significant difference in psychological consequence scores between the two groups (p = 0.53). After the recommendation, the total psychological consequence score and the emotional and social functioning subscales were significantly higher in the acceptance group compared with the refusal group (p < 0.05). The mean difference in total psychological consequence scores between the two groups was 0.82. In the acceptance group, total psychological consequence scores increased significantly after the screening recommendation (p < 0.001). Psychological consequences were inversely associated with age and income (p < 0.05); however, no significant associations were found with education level or number of children.

The findings indicate that recommending mammography screening is accompanied by increased psychological consequence scores, particularly in emotional and social domains. Age and income were identified as factors associated with psychological consequences. These results suggest that the screening process may elicit considerable psychological responses among women. Therefore, future interventional studies are recommended to evaluate the effects of educational and psychological support programs prior to screening on mitigating these consequences. From a public health policy perspective, addressing the psychological aspects of screening may improve women's experiences within national screening programs.