False-Positive Results and Return to Screening Mammography
New BCSC study reveals another unintended consequence of false positives
False-positive mammograms discourage some women from future screenings
Early detection of breast cancer through mammography screening continues to save lives. However, abnormal findings on mammograms can lead to women being recalled for additional imaging and biopsies, most of which turn out to be “false positives,” meaning they do not result in a cancer diagnosis. These false positives can cause significant emotional distress, inconvenience, and out-of-pocket expenses.
A new study from the Breast Cancer Surveillance Consortium (BCSC) has revealed another unintended consequence of false positives: women who received a false-positive result requiring additional imaging or biopsy were less likely to return for future screenings.
Published in the Annals of Internal Medicine on September 3, 2024, the study analyzed data from more than 3.5 million screening mammograms performed nationwide between 2005 and 2017 on over 1 million patients aged 40 to 73. The findings showed that 77% of women with a true negative mammogram result returned for subsequent screenings within the following 30 months. However, this percentage dropped to 61% among women who had a false-positive finding requiring a repeat diagnostic mammogram in six months (i.e., a short-interval follow-up mammogram) to evaluate for changes, and to 67% among those who were recommended for a biopsy. The impact was even more pronounced for women who received false-positive recommendations for short-interval follow-up on two consecutive screening mammograms—only 56% returned their next screening mammogram.
The research also identified disparities among different demographic groups: Asian and Hispanic/Latinx women were the least likely to return for future screenings after a false-positive result, potentially contributing to existing health disparities.
False-positive results are common, particularly among younger women. They occur in 10-12% of mammograms for women aged 40-49 years. After 10 years of annual screenings, 50-60% of women can expect at least one false-positive recall, and 7-12% will have a benign biopsy. These 10-year rates are cut nearly in half with screening every 2 years instead of annual screening. While most women recalled for additional imaging do not have breast cancer, it’s important to remember that these recalls are precautionary. Women who experience false-positive results should continue screening every 1 to 2 years, as a false-positive—especially if it results in a diagnosis of benign breast disease—is associated with an increased risk of being diagnosed with breast cancer in the future. Cancer risk also increases with age.
Miglioretti DL, Abraham L, Sprague BL, Lee CI, Bissell MCS, Ho TH, Bowles EJA, Henderson LM, Hubbard RA, Tosteson ANA, Kerlikowske K. Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort. Ann Intern Med. 2024 Sep 3. doi: 10.7326/M24-0123. Epub ahead of print. PMID: 39222505.. [Link]
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