title: Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study.
abstract: BACKGROUND
  False-positive mammography results are common. Biennial screening may decrease the cumulative probability of false-positive results across many years of repeated screening but could also delay cancer diagnosis.
  
  
  OBJECTIVE
  To compare the cumulative probability of false-positive results and the stage distribution of incident breast cancer after 10 years of annual or biennial screening mammography.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  7 mammography registries in the National Cancer Institute-funded Breast Cancer Surveillance Consortium.
  
  
  METHODS
  169,456 women who underwent first screening mammography at age 40 to 59 years between 1994 and 2006 and 4492 women with incident invasive breast cancer diagnosed between 1996 and 2006.
  
  
  METHODS
  False-positive recalls and biopsy recommendations stage distribution of incident breast cancer.
  
  
  RESULTS
  False-positive recall probability was 16.3% at first and 9.6% at subsequent mammography. Probability of false-positive biopsy recommendation was 2.5% at first and 1.0% at subsequent examinations. Availability of comparison mammograms halved the odds of a false-positive recall (adjusted odds ratio, 0.50 [95% CI, 0.45 to 0.56]). When screening began at age 40 years, the cumulative probability of a woman receiving at least 1 false-positive recall after 10 years was 61.3% (CI, 59.4% to 63.1%) with annual and 41.6% (CI, 40.6% to 42.5%) with biennial screening. Cumulative probability of false-positive biopsy recommendation was 7.0% (CI, 6.1% to 7.8%) with annual and 4.8% (CI, 4.4% to 5.2%) with biennial screening. Estimates were similar when screening began at age 50 years. A non-statistically significant increase in the proportion of late-stage cancers was observed with biennial compared with annual screening (absolute increases, 3.3 percentage points [CI, -1.1 to 7.8 percentage points] for women age 40 to 49 years and 2.3 percentage points [CI, -1.0 to 5.7 percentage points] for women age 50 to 59 years) among women with incident breast cancer.
  
  
  CONCLUSIONS
  Few women underwent screening over the entire 10-year period. Radiologist characteristics influence recall rates and were unavailable. Most mammograms were film rather than digital. Incident cancer was analyzed in a small sample of women who developed cancer.
  
  
  CONCLUSIONS
  After 10 years of annual screening, more than half of women will receive at least 1 false-positive recall, and 7% to 9% will receive a false-positive biopsy recommendation. Biennial screening appears to reduce the cumulative probability of false-positive results after 10 years but may be associated with a small absolute increase in the probability of late-stage cancer diagnosis.
  
  
  BACKGROUND
  National Cancer Institute.
authors: Group Health Cooperative and School of Public Health of the University of Washington, Seattle, USA. hubbard.r@ghc.org
authors: Rebecca A
authors: RA
authors: Hubbard
authors: Karla
authors: K
authors: Kerlikowske
authors: Chris I
authors: CI
authors: Flowers
authors: Bonnie C
authors: BC
authors: Yankaskas
authors: Weiwei
authors: W
authors: Zhu
authors: Diana L
authors: DL
authors: Miglioretti
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011446:Prospective Studies; D013997:Time Factors