1. In this cohort study, women were less likely to return for mammogram screening if their original result was a false-positive versus a true-negative.

2. Racial disparities in return mammogram screening were present, with Asian and Hispanic/Latinx women having the greatest reduction in likelihood of returning after a false-positive result.

Evidence Rating Level: 2 (Good)

Study Rundown: Breast cancer screening is an essential part of a secondary prevention strategy to reduce breast cancer mortality. Although the benefits are remarkable, mammography inevitably results in some number of false positive results leading to further imaging and biopsies, as well as higher financial burden. While prior studies have investigated the relationship between false-positive mammogram results and likelihood to return for subsequent screening, they have had contradictory results and largely did not evaluate for differences in effect by racial or ethnic group. This observational cohort study of over 1 million women was designed to determine the association between mammography screening results and future participation in routine screening. Overall, it was found that women who had a false positive mammography result were less likely to return to screening, particularly if they were given recommendations for a biopsy or short-interval follow-up. Further, women with two consecutive false-positive results were even less likely to return for screening as compared to those with one false-positive and one true-negative result. This study was limited by a relatively short timeframe as well as the possibility that return to screening occurred at other facilities not included within the capture area. In summary, women were less likely to return to routine breast cancer screening after receiving a false-positive result.

Click here to read the study in AIM

Relevant Reading: Impact of a false positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis

In-Depth [retrospective cohort]: This observational study enrolled 1,053,672 women aged 40 to 73 years with screening mammograms from 177 facilities participating in the Breast Cancer Surveillance Consortium (BCSC). A total of 3,529,825 screening mammograms were included, with 3,184,482 true negatives and 345,343 false positives. Overall, 75.9% (CI, 74.0% to 77.6%) of women returned for an additional screening within 9 to 30 months of their first screening mammogram. Women were more likely to return if they originally received a true-negative result (76.9%; CI, 75.1% to 78.6%), while women were less likely to return if they had an original false-positive test with immediate additional imaging (adjusted absolute difference, -1.9 percentage points; CI, -3.1 to -0.7 percentage points). Women were much less likely to return if they had a false-positive with recommendation for short-interval follow-up (adjusted absolute difference, -15.9 percentage points; CI, -19.7 to -12.0 percentage points) or biopsy (adjusted absolute difference, -10.0 percentage points; CI, -14.2 to -5.9 percentage points). This effect was most pronounced among Asian and Hispanic/Latinx women, with absolute differences of -20 to -25 percentage points and -13 to -14 percentage points for recommendations of short-interval follow-up or biopsy, respectively. For women who had 2 screening mammograms in a 5-year period, receiving a false positive on the second screening test was associated with a lower likelihood of returning for a third test, regardless of the first screening result.

Image: PD

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