title: Likelihood of early detection of breast cancer in relation to false-positive risk in life-time mammographic screening: population-based cohort study.
abstract: BACKGROUND
  Women require balanced, high-quality information when making an informed decision on screening benefits and harms before attending biennial mammographic screening.
  
  
  METHODS
  The cumulative risk of a false-positive recall and/or (small) screen-detected or interval cancer over 13 consecutive screening examinations for women aged 50 from the start of screening were estimated using data from the Nijmegen programme, the Netherlands.
  
  
  RESULTS
  Women who underwent 13 successive screens in the period 1975-1976 had a 5.3% cumulative chance of a screen-detected cancer, with a 4.2% risk of at least one false-positive recall. The risk of being diagnosed with interval cancer was 3.7%. Two decades later, these estimates were 6.9%, 7.3% and 2.9%, respectively. The chance of detection of a small, favourable invasive breast cancer, anticipating a normal life-expectancy, rose from 2.3% to 3.7%. Extrapolation to digital screening mammography indicates that the proportion of false-positive results will rise to 16%.
  
  
  CONCLUSIONS
  Dutch women about to participate in the screening programme can be reassured that the chance of false-positive recall in the Netherlands is relatively low. A new screening policy and improved mammography have increased the detection of an early screening carcinoma and lowering the risk of interval carcinoma.
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, Nijmegen. Electronic address: j.otten@ebh.umcn.nl.
authors.forename: J D M
authors.initials: JDM
authors.lastname: Otten
authors.affiliation: Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam.
authors.forename: J
authors.initials: J
authors.lastname: Fracheboud
authors.affiliation: National Expert and Training Center for Breast Cancer Screening, Nijmegen, the Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: den Heeten
authors.affiliation: Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam.
authors.forename: S J
authors.initials: SJ
authors.lastname: Otto
authors.affiliation: National Expert and Training Center for Breast Cancer Screening, Nijmegen, the Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Holland
authors.affiliation: Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam.
authors.forename: H J
authors.initials: HJ
authors.lastname: de Koning
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, Nijmegen; National Expert and Training Center for Breast Cancer Screening, Nijmegen, the Netherlands.
authors.forename: M J M
authors.initials: MJM
authors.lastname: Broeders
authors.affiliation: Department for Health Evidence, Radboud University Medical Centre, Nijmegen.
authors.forename: A L M
authors.initials: ALM
authors.lastname: Verbeek
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D012306:Risk
keywords: breast neoplasm; cumulative risk; false-negative reactions; false-positive reactions; mammography; mass screening