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Women aged 40-49 more likely to have a false-positive mammography
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False-positive mammography screening results appeared most common among women aged 40 to 49 years and among those with specific risk factors, according to findings from a multi-institutional study.
However, the rate of false-negative results or recommendations for biopsy did not differ based on age.
Heidi D. Nelson
"Our research found that false-positive mammography results are common, while false-negatives are low,” Heidi D. Nelson, MD, MPH, research professor in the departments of medical informatics and clinical epidemiology and medicine at Oregon Health Sciences University told HemOnc Today. “False-positive rates were particularly high for younger women and those with risk factors, including family history of breast cancer, previous benign breast biopsy, high breast density, and, in younger women only, low body mass index.”
Nelson and colleagues sought to identify factors associated with false-positive and false-negative mammography results as well as recommendations for additional imaging and/or biopsies among the general population of women who are screened for breast cancer.
The researchers identified 405,191 women aged 40 to 89 years who were screened between 2003 and 2011 and were part of one of the five U.S. Breast Cancer Surveillance Consortium registries.
Overall, 2,963 women (.007%) were diagnosed with invasive cancer or ductal carcinoma in situ within 1 year of being screened.
The rate of false-positive results and recommendations for additional imaging appeared highest among women in their forties. In this cohort, 121.2 of 1,000 women screened (95% CI, 105.6-138.7) had a false-positive result and 124.9 of 1,000 women (95% CI, 109.3-142.3) received recommendations for additional screening.
Other rates of false-positive results decreased with age (50-59 age group, 93.2 per 1,000; 95% CI, 82.8-104.7; 60-69 group, 80.8 per 1,000; 95% CI, 72.9-89.4; 70-79 group, 69.6; 95% CI, 62.6-77.3; 80-89 group, 65.2; 95% CI, 58.8-72.2).
Likewise, the rate of additional imaging recommendations decreased with each age group (50-59 group, 98.5 per 1,000; 95% CI, 88-110.1; 60-69 group, 88.7 per 1,000; 95% CI, 80.6-97.4; 70-79 group, 79 per 1,000; 95% CI 71.9-86.9; 80-89 group, 74.4 per 1,000; 95% CI, 67.4-82.2).
The rate of false-negative results ranged from 1.0 to 1.5 per 1,000 women and the recommendations for biopsy ranged from 15.6 to 17.5 per 1,000 women; however, the differences by age group did not reach statistical significance. Results also did not differ based on the time since the last mammography screening.
Several risk factors, such as family breast cancer history, a higher breast density or previous benign biopsy results, were associated with higher rates of false-positive and false-negative results across most age groups.
Other risk factors, such as being premenopausal, use of menopausal hormone therapy and a lower BMI were associated with some outcomes based on age. For instance, women who were premenopausal had higher rates of false-positive results than perimenopausal and postmenopausal women in the 40 to 49 age group (131.3 per 1,000; 95% CI, 113.3-151.8) and 50 to 59 age group (118.3 per 1,000; 95% CI, 107.2-130.5).
The rate of false-positive results also appeared higher among women using hormonal therapy aged 70 to 79 years (67.6 per 1,000; 95% CI, 61.1-74.8) and among women with a lower BMI aged 40 to 49 years (BMI ˂ 25, 129 per 1,000; 95% CI, 113.8-145.9).
The researchers noted confounding characteristics and outcomes across the five registries and regions may have been present in the study. Additionally, some risk factors, such as the amount of first- or second-degree relatives with breast cancer and the diagnoses associated with previous biopsies that were benign were not examined.
"The results of this study may be useful in personalizing the benefits and harms of breast cancer screening for individual women,” Nelson said. – by Anthony SanFilippo
For more information:
Heidi D. Nelson, MD, MPH, can be reached at nelsonh@ohsu.edu.
Disclosure: The researchers report no relevant financial disclosures.
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