Patients may be less likely to return for subsequent screening mammography following a false-positive recall for additional imaging or biopsy, according to a recent study published by Miglioretti et al in the Annals of Internal Medicine. The findings raised concerns regarding the potential unintended consequences of false-positive results on the continued participation of patients in routine breast cancer screening.
Background
Cancer screening is designed to detect cancer early and improve patient outcomes. Early detection of breast cancer through screening mammography continues to save lives. Patients who receive abnormal findings on mammograms can be recalled for additional imaging and biopsies. Nonetheless, breast cancer screening may come with risks such as false positives, which are more common in younger patients with denser breast tissue. These results can have financial implications and cause significant emotional anxiety.
False-positive results are common, occurring in 10% to 12% of screening mammographs in patients aged 40 to 49 years. After 10 years of annual screenings, 50% to 60% of patients can expect at least one false-positive result and 7% to 12% can expect at least one false-positive result with a biopsy recommendation.
“It is important for women with false-positive results to continue screening every 1 to 2 years,” explained lead study author Diana Miglioretti, PhD, Chief of the Division of Biostatistics and a cancer center researcher at the University of California, Davis. “Having a false-positive result, 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,” she added.
Study Methods and Results
In the large, multicenter cohort study, investigators evaluated the association between screening mammography results and the probability of subsequent screening in over 3.5 million screening mammograms performed from 2005 and 2017 in over 1 million patients aged 40 to 73 years. The screenings occurred at 177 breast imaging facilities participating in six U.S.-based Breast Cancer Surveillance Consortium registries. The cohort included information on age, race, and ethnicity as well as at least 30 months of data collection following screening mammography to capture subsequent screening and breast cancer diagnosis.
The investigators noted whether the patient had a true-negative result or a false-positive recall in which they were recommended for immediate additional imaging only, short-interval follow-up, or biopsy. The investigators then assessed the absolute differences in the probability of returning for screening mammography within 9 to 30 months depending on screening result.
The investigators discovered that 77% of the patients with a true-negative result returned for subsequent screening; however, this percentage decreased by 2% following a false-positive recall for additional imaging only, 16% following a false-positive short-interval follow-up recommendation, and 10% following a false-positive biopsy recommendation. Additionally, Asian and Hispanic/Latinx patients were found to be the least likely to return for future screening mammograms following a false-positive result—which may contribute to existing health disparities.
Conclusions
“The finding raises concerns about the potential unintended consequence of false-positive results, where women may avoid screening mammograms in the future,” stressed Dr. Miglioretti. “It’s important to understand that most women recalled for additional imaging [because of] a finding on a screening mammogram do not have breast cancer. They should try not to be worried if they are recalled for additional work-up. it is a normal and common part of the screening process,” she underscored.
The investigators advised patients who feel anxious while waiting for their screening mammography results to consider requesting an on-the-spot interpretation of their mammogram. Some facilities may provide this service along with a same-day diagnostic work-up if there is a suspicious finding. They suggested that physicians should carefully explain false-positive results to their patients to reassure them that the result was negative and stress the importance of continued screening.
In an accompanying editorial, investigators suggested that the findings may raise critical questions about breast cancer screening, especially the guideline-recommended age to initiate screening mammography.
The 2024 U.S. Preventive Services Task Force currently recommends beginning breast cancer screening at 40 years. In the study, 29% of the patients were aged 40 to 49 years and 35.8% of them were aged 50 to 59 years. Because screening for ages 40 to 49 years wasn't standard when the study was conducted, the investigators noted that future studies may be needed to better understand the factors contributing to decreased breast cancer screening attendance following false-positive results and to evaluate interventions to improve subsequent screening mammography rates.
Disclosure: For full disclosures of the study authors, visit acpjournals.org.
