False positive breast screens may discourage further testing

Women who receive a false positive reading during a breast cancer screening may be less likely to engage in subsequent tests, new research suggests.
 
The study, published in the Annals of Internal Medicine, included a large cohort of over three million screening mammograms for over one million patients aged 40–73, and found significant drops in participation if women had a false positive recall for additional imaging or biopsy.
 
The researchers say their findings raise concerns about the potential unintended consequence of false positive results on the continued participation of women in routine breast cancer screening, with false positives being more common in younger women with denser breast tissue.
 
The authors looked at the differences in probability of returning for a screening between nine and 30 months, based on the screening result.
 
While 77% of women with a true negative result returned for subsequent screening, the results showed the percentage points dropped 2% following a false positive recall for additional imaging.
 
More significantly, there was a 16% drop following a false positive short interval follow-up recommendation and 10% drop following a false positive biopsy recommendation.
 
Dr Katrina Tiller, Chair of RACGP Specific Interests Breast Medicine, told newsGP  Australian research also indicates a decline in screening following false positives, but the benefits outweigh the risks.
 
‘The rate of attendance after recall is still higher than background,’ Dr Tiller said.
 
‘We know that if women start screening and attend more than once, they are more likely to continue.
 
‘A good habit can be formed.’
 
According to BreastScreen Australia, more than half of all women under the age of 50 have dense breasts, as do about 40% of women in their 50s, often making cancer detection more difficult.
 
Previous calls to lower the breast cancer screening age in Australia by a decade had experts cautiously stating that targeted screening would be preferrable.
 
In the BreastScreen Australia program, women can access free mammograms every two years from age 40, with women aged 50–74 considered the target group for testing.
 
Dr Tiller says women in their 40s should still be encouraged to screen, but the approach might be more personalised.
 
‘There’s lots of evidence that says first mammograms have the highest recall rate, and then from there, after their subsequent visits, their recall rates are around halved,’ she said.
 
She said GPs can help patients prepare for what to expect from the procedure.
 
‘Giving women information first empowers them as they go in, rather than them being surprised and disgruntled by what’s happened,’ she said.
 
Using tools like iPrevent and speaking one-on-one with patients, Dr Tiller says, can address uncertainty.
 
‘We’ve got to continue to talk to our ladies and give them good advice about what their risk is,’ she said.
 
According to data collected from BreastScreen Australia from 2021 and 2022, the age-standardised participation rate of females aged 50–74 years and 50–69 years was correspondingly 49.6% and 49.2%.
 
It was at its lowest, 37.1%, among females aged 50–74 years living in very remote areas.
 
Dr Tiller says these low testing rates and how to tailor screening for younger ages are currently being reviewed.
 
‘BreastScreen Australia is addressing issues of screening age, what to do with mammographic density and how to personalise screening,’ she said.
 
‘Do we do with the 40-year-olds, the same as what we do with the 75-year-olds?
 
‘It’s bit of a “watch this space” but keep encouraging women.’
 
Log in below to join the conversation.

breast cancer breast screening cancer screening mammogram preventive health