Half of all women experience false positive mammograms after 10 years of annual screening
Study examined breast cancer screening using tomosynthesis and digital mammography

Date:
March 25, 2022
Source:
University of California - Davis Health
Summary:
Half of all women experience a false positive mammogram after 10
years of annual breast cancer screening with 3D mammography, a UC
Davis-led study estimates. This risk was lower for women who had
mammograms every other year. 3D screening showed slightly lower
false positive results than standard mammography.



FULL STORY ==========================================================================
A study led by UC Davis Health has found that half of all women
will experience at least one false positive mammogram over a decade
of annual breast cancer screening with digital breast tomosynthesis
(3D mammography). The risk of false positive results after 10 years of screening is considerably lower in women screened every other year. A
false positive is when a mammogram is flagged as abnormal, but there is
no cancer in the breast.


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The study was published today in JAMA Network Open.

It also showed that repeated breast cancer screening with 3D mammography
only modestly decreases the chance of having a false positive result
compared with the standard digital 2D mammography. Other factors more
strongly linked to a lower false positive risk included screening every
other year and having non- dense breasts. Older women were also less
likely to have a false positive result.

"The screening technology did not have the largest impact on reducing
false positives," said Michael Bissell, epidemiologist in the UC
Davis Department of Public Health Sciences and co-first author
of the study. "Findings from our study highlight the importance of patient-provider discussions around personalized health. It is important
to consider a patient's preferences and risk factors when deciding on
screening interval and modality." False positive mammograms are common
Breast cancer is the second leading cause of cancer-related death for
women in the U.S. Early detection using screening mammography is a key
strategy to lower the risk of advanced breast cancer and death from
this disease.



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A false positive result is a positive screening mammography assessment
that leads to more diagnostic work-up but no diagnosis of breast
cancer. When abnormalities are found on a mammogram, the patient is
recalled for additional imaging and follow-up tests. If found to be
cancer-free at the end of diagnostic evaluation and for one year after
her recall, the patient is considered to have received a false positive
result.

"Despite the important benefit of screening mammography in reducing breast cancer mortality, it can lead to extra imaging and biopsy procedures,
financial and opportunity costs, and patient anxiety," said Diana
Miglioretti, professor and division chief of biostatistics at the UC
Davis Department of Public Health Sciences, UC Davis Comprehensive Cancer Center researcher and senior author of the study.

False positive results are common. While around 12% of 2D screening
mammograms are recalled for more work-up, only 4.4% of those recalls,
or 0.5% overall, conclude with a cancer diagnosis.

"To detect breast cancer early, we need to be careful and investigate
any potentially abnormal findings. So, women should not be worried if
recalled for additional imaging or biopsy. The vast majority of these
results are found to be benign," said Thao-Quyen Ho, radiologist at the University Medical Center in Ho Chi Minh, Vietnam, research fellow at
UC Davis School of Medicine and co- first author on the study.

Analyzing mammograms for false positive results The researchers analyzed
data collected by the Breast Cancer Surveillance Consortium on 3 million screening mammograms for 903,495 women aged 40-79 years. The screenings
were performed between 2005-2018 at 126 radiology facilities.



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The study evaluated screening modality, screening interval, age and breast density. It estimated the cumulative risk that a woman would receive at
least one false positive recall over 10 years of annual or biennial (every other year) screening. It also assessed the risks of a false positive
that resulted in a recommendation to repeat imaging within six months
(short interval follow- up) and separately, in a biopsy recommendation.

Mammography versus tomosynthesis for breast cancer screening The study
found that the probability of receiving at least one false positive
recall over a 10-year period was slightly lower with 3D than 2D digital mammography. The decrease in false positives with 3D vs. 2D mammography
was greatest for women with non-dense breasts and those who had annual screenings.

The researchers estimated that over 10 years of annual tomosynthesis
screening, 50% of women will experience at least one false positive
recall, 17% a false positive short-interval follow-up recommendation,
and 11% a false positive biopsy recommendation. This is compared to 56%
of women screened with 2D digital mammograms having a false positive
recall, 18% a short-interval follow- up recommendation, and 12% a biopsy recommendation.

Regardless of the type of screening, false positive results were
substantially lower for older than younger age groups and women with
entirely fatty versus extremely dense breasts.

Annual versus biennial breast cancer screening The study also estimated
10-year risks for annual vs. biennial screenings. It found that screening
every other year showed a considerably lower probability of at least
one false positive result than annual mammograms over ten years of
screening. This finding was observed for both 3D and 2D mammography.

"We were surprised that the newer 3D technology in breast cancer screening
does not substantially reduce the risk of having a false positive result
after 10 years of screening; however, chances of false positives are
much lower with repeated biennial vs. annual screening," said Ho.

For short-interval follow-up recommendations, 17% of women undergoing
annual 3D mammography are estimated to have at least one false positive
over 10 years, compared to just 10% of those undergoing biennial
screening. False positive benign biopsy recommendations are estimated
to occur in 11% of women receiving annual 3D mammograms but in only 7%
of those screened every two years.

After 10 years of annual screening, the risk of a false positive result
was lower in 3D than 2D mammography for all outcomes. For biennial
screening, the risk of a false positive recall was lower with 3D
mammography. There was no difference in short interval follow-up or
biopsy recommendations.

The other authors on this study are: Karla Kerlikowske and Jeffrey A. Tice
at the University of California, San Francisco; Rebecca A. Hubbard at
the University of Pennsylvania; Brian L. Sprague at the University of
Vermont; Christoph I. Lee at the University of Washington and Hutchinson Institute for Cancer Outcomes Research; and Anna N. A. Tosteson at
Dartmouth College and Norris Cotton Cancer Center. Miglioretti is also
an affiliate investigator with UC Davis Center for Healthcare Policy
and Research and Kaiser Permanente Washington Health Research.


========================================================================== Story Source: Materials provided by
University_of_California_-_Davis_Health. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. Thao-Quyen H. Ho, Michael C. S. Bissell, Karla Kerlikowske,
Rebecca A.

Hubbard, Brian L. Sprague, Christoph I. Lee, Jeffrey A. Tice,
Anna N. A.

Tosteson, Diana L. Miglioretti. Cumulative Probability of
False-Positive Results After 10 Years of Screening With Digital
Breast Tomosynthesis vs Digital Mammography. JAMA Network Open,
2022; 5 (3): e222440 DOI: 10.1001/jamanetworkopen.2022.2440 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/03/220325122711.htm

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