False-positive mammograms linked with reduced uptake of future screening
Women were particularly unlikely to return after a false-positive result if they were referred for short-interval follow-up or a biopsy or if they were Asian or Hispanic/Latinx, a large analysis of mammography in the U.S. found.
Women who receive false-positive mammogram results are less likely to return to screening, especially if they had a false positive on two sequential screening mammograms or if the recall resulted in a recommendation for short-interval follow-up or biopsy, a cohort study found.
To investigate the association between screening mammography results and subsequent screening, researchers assessed 3,529,825 screening mammograms performed from 2005 to 2017 among 1,053,672 women at 177 facilities participating in the Breast Cancer Surveillance Consortium. All women were ages 40 to 73 years at the time of screening (mean age, 55.6 years) and did not have a breast cancer diagnosis. Findings were published by Annals of Internal Medicine on Sept. 3.
Of the screening mammograms included, 3,184,482 were true negatives and 345,343 were false positives (9.8%). Of the false positives, 5.8% were recommended for immediate additional imaging only, 2.7% were recommended for short-interval follow-up, and 1.3% were recommended for biopsy. Women were more likely to return to screening after receiving a true-negative result (76.9%; 95% CI, 75.1% to 78.6%) than after a false-positive recall for additional imaging only (adjusted absolute difference, −1.9 percentage points [95% CI, −3.1 to −0.7 percentage points]), short-interval follow-up (−15.9 percentage points [95% CI, −19.7 to −12.0 percentage points]), or biopsy (−10.0 percentage points [95% CI, −14.2 to −5.9 percentage points]).
The largest decreases in the probability of returning after a false-positive for short-interval follow-up (−20 to −25 percentage points) or biopsy (−13 to −14 percentage points) versus a true negative were among Asian and Hispanic/Latinx women. For women who completed two screening mammograms within five years, a false-positive result on the second mammogram was associated with a decreased probability of returning for a third regardless of the first screening result. Women were also less likely to return for another screening if they had false-positive results on two sequential screenings.
A limitation to the study is that it did not include data on women who received follow-up care at facilities outside the screening consortium.
The findings raise “concerns about the potential unintended consequence of false-positive results on the continued participation of women in routine screening,” the study authors wrote.
“Physicians should educate their patients about the importance of continued screening after false-positive results, especially given the associated increased future risk for breast cancer,” they concluded.
An accompanying editorial noted the study did not include information on patients' income, employment, access to health care, health insurance, and language barriers. “Although this study is an important first step to understanding the implications of race in the context of mammographic results influencing breast cancer screening behaviors, future studies may require further detail to understand the disparities and their underlying reasons,” the editorialists wrote.
Providing all women with clear health care information on the benefits and harms of breast cancer screening could help improve screening uptake among patients who receive false-positive results, the editorial concluded.