Value of breast imaging in women with painful breasts

BMJ 1999;318:1009 ( 10 April )

Letters

Value of breast imaging in women with painful breasts

Negative results are not reassuring

Women with severe problems must be seen in specialist breast clinics

Negative results are not reassuring

The first 150 words of the full text of this article appear below.

EDITOR $---$ Duijm et al conclude that the primary value of breast imaging in women with painful breasts seems to be that of reassurance,as no abnormalities are usually detected.¹ Had they measuredthe level of reassurance that their negative results provided,it seems unlikely they would have come to thisconclusion.

There is increasing evidence that negative results of tests at best provide little reassurance and at worst can increase anxietylevels and do considerable harm.^2-4 A recent review concludedthat "medical reassurance as currently practised is both ineffectiveand theoretically contraindicated."⁵ The perpetuation of themyth that patients are reassured by negative results is outdatedand potentiallydangerous.

Richard D Neal, Lecturer in primary care research.
Centre for Research in Primary Care, Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL rmrrdn@hyde.leeds.ac.uk

Stephen Morley, Professor of clinical psychology.
Division of Psychiatry and Behavioural Science in Relation to Medicine, University of Leeds

^a Competing interests: Nonedeclared.

Duijm LEM, Guit GL, Hendriks JHCL, Zaat JOM, Mali WPTM. Value of breast imaging in women with painful breasts: observational follow up study. BMJ 1998; 317: 1492-1495[Abstract/Free Full Text]. (28 November.)
McDonald IG, Daly J, Jelinek VM, Panetta F, Gutman JM. Opening Pandora's box: the unpredictability of reassurance by a normal test result. BMJ 1996; 313: 329-332[Abstract/Free Full Text].
Fitzpatrick R. Telling patients there is nothing wrong. BMJ 1996; 313: 311-312[Free Full Text].
Lucock MP, Morley S, White C, Peake MD. Responses of consecutive patients to reassurance after gastroscopy: results of self administered questionnaire survey. BMJ 1997; 315: 572-575[Abstract/Free Full Text].
Coia P, Morley S. Medical reassurance and patients' responses. J Psychosom Res 1998; 45: 377-386[Medline].

Women with severe problems must be seen in specialist breast clinics

EDITOR $---$ Duijm et al have confirmed that ultrasonography of the breast and mammography are of little diagnostic value in womenwith breast pain in the absence of clinical signs.¹ We do notagree, however, with their conclusion that carrying . . . [Full text of this article]

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Relevant Article

Value of breast imaging in women with painful breasts: observational follow up study: Lucien E M Duijm, Gerard L Guit, Jan H C L Hendriks, Joost O M Zaat, and Willem P T M Mali
BMJ 1998 317: 1492-1495. [Abstract] [Full Text] [PDF]

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