Positive findings of mammography may lead to suicide

Editor—I S Tobias and Michael Baum postulate that false positive findings of mammography will have psychological consequences.1 We report two cases of suicide in women with positive results of mammography.

As part of the Health of the Nation strategy for mental illness we examined our local coroner's records for suicide and undetermined deaths for the years 1992-5. Undetermined deaths were included to avoid problems of misclassification. In women aged 50-64 there were 12 recorded deaths. Two, both classified as suicides, occurred between the women receiving notification of recall after mammography and reattending.

The first woman was under follow up after a mastectomy in 1986. She was not thought by her general practitioner or relatives to have been depressed. Her suicide note was written on her recall letter, and no other reason was given. The second woman had a history of depression and alcohol problems and was screened as part of the national programme; this led to an appointment for investigation of a suspected lesion. She left a suicide note mentioning her fear of admission to hospital but no other factor. Neither woman had attempted suicide previously or expressed any intention of doing so, but both had had children who had died of disseminated (non-breast) cancer.

It is not possible to be sure about cause and effect in these two cases. Both of the women may have been vulnerable, and the recall letter may simply have been the final straw. Both these deaths, however, would have been missed by the British studies of psychiatric morbidity associated with screening for breast cancer.2 3 Apart from the small numbers studied, these studies selected only women with normal results of screening2 or who had attended for investigation of a positive result.3 To our knowledge this is the first report suggesting that adverse psychological effects of mammography might also include death; hence reduction in all cause mortality should be a part of the evaluation of mass mammography. In the meantime, it may be of some reassurance that, nationally, the trends in suicide in women in this age group over 1986-94 remain downwards.4