title: Clinical and radiological features of breast tumors according to history of false-positive results in mammography screening.
abstract: BACKGROUND
  Women with a false-positive result after a screening mammogram have an increased risk of cancer detection in subsequent participations, especially after assessments involving cytology or biopsy. We aimed to compare women's personal characteristics, tumoral features and the radiological appearance of cancers with and without a previous false-positive result generated by additional imaging or invasive procedures.
  
  
  METHODS
  From 1996 to 2007, 111,098 women aged 45-69 years participated in four population-based breast cancer screening programs in Spain, and 1281 cancers were detected. We included all cancers detected in subsequent screenings (n=703) and explored the occurrence of previous false-positive results. We identified false-positives requiring additional imaging or invasive procedures. Differences on tumoral features (invasiveness, tumor size, and lymph node status) and radiological appearance were assessed by Chi-square test, and agreement between the location of cancer and prior suspicious by Cohen's kappa coefficient. A multivariate analysis was preformed to evaluate the effect of previous screening results and age on the odds of presenting an in situ carcinoma.
  
  
  RESULTS
  Among the 703 cancers detected in subsequent screenings, 148 women (21.1%) had a previous false-positive result. Of these, 105 were by additional imaging and 43 by invasive procedures. Women with prior false-positive result requiring invasive assessment, compared to women with negative tests, and women with prior false-positive requiring additional imaging, had a higher proportion of in situ carcinomas (31.7%, 15.3%, 12.9%, respectively; p=0.014) and microcalcifications (37.2%, 20.2%, 9.5%, respectively; p=0.003). The proportion of in situ carcinomas was even higher in women over 60 years (39.2%, 12.5%, 13.0%, respectively; p=0.001). Ipsilateral cancer was observed in 65.7% of cases with prior cytology or biopsy (k=0.479; 95%CI: 0.330-0.794).
  
  
  CONCLUSIONS
  A large number of in situ malignancies and calcification patterns were found among women with prior false-positive result in mammography screening requiring cytology or biopsies, suggesting progression from a previously benign lesion.
authors: Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Research Institute), C/ Dr. Aiguader, 88, 08003 Barcelona, Spain. LDomingo@parcdesalutmar.cat
authors: Laia
authors: L
authors: Domingo
authors: Anabel
authors: A
authors: Romero
authors: Jordi
authors: J
authors: Blanch
authors: Dolores
authors: D
authors: Salas
authors: Mar
authors: M
authors: Sánchez
authors: Ana
authors: A
authors: Rodríguez-Arana
authors: Joana
authors: J
authors: Ferrer
authors: Josefa
authors: J
authors: Ibáñez
authors: Alfonso
authors: A
authors: Vega
authors: M Soledad
authors: MS
authors: Laso
authors: Xavier
authors: X
authors: Castells
authors: Maria
authors: M
authors: Sala
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards; D008875:Middle Aged; D012306:Risk; D013030:Spain / Q000453:epidemiology
keywords: Biopsy; Breast neoplasms; Carcinoma in situ; False positives; Fine-needle; Mass screening