title: The burden of false-positive results in analog and digital screening mammography: experience of the Nova Scotia Breast Screening Program.
abstract: OBJECTIVE
  The Canadian Task Force on Preventive Health Care released recommendations for breast cancer screening, in part, based on harms associated with screening. The purpose of this study was to describe the rate of false-positive (FP) screening mammograms and to describe the extent of the investigations after an FP.
  
  
  METHODS
  A cohort was identified that consisted of all screening mammograms performed through the Screening Program (2000-2011) with patients ages 40-69 years at screening. Rates of FP screening mammograms were calculated as well as rates of further investigations required, including additional imaging, needle core biopsy, and surgery. Analyses were stratified by 10-year age group, screening status (first vs rescreen), and technology.
  
  
  RESULTS
  A total of 608,088 screening mammograms were included. The FP rate varied by age group, and decreased with increasing age (digital, 40-49 years old, FP = 8.0%; 50-59 years old, FP = 6.3%; 60-69 years old, FP = 4.6%). The FP rate also varied by screening status (digital, first screen, FP = 12.0%; rescreen, FP = 5.6%), and this difference was consistent across age groups. The need for further investigation varied by age group, with invasive procedures being more heavily used as women age (digital, rescreen group, surgery: 40-49 years old, 1.1%; 50-59 years old 1.6%, 60-69 years old, 1.8%).
  
  
  CONCLUSIONS
  Both the FP screening mammogram rate and the degree to which further investigation was required varied by age group and screening status. Reporting on these rates should form part of the evaluation of screening performance.
authors.affiliation: Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Breast Screening Program, Halifax, Nova Scotia, Canada; Department of Diagnostic Imaging, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada. Electronic address: jennifer.payne@dal.ca.
authors.forename: Jennifer I
authors.initials: JI
authors.lastname: Payne
authors.affiliation: Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Tetyana
authors.initials: T
authors.lastname: Martin
authors.affiliation: Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Breast Screening Program, Halifax, Nova Scotia, Canada; Department of Diagnostic Imaging, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada.
authors.forename: Judy S
authors.initials: JS
authors.lastname: Caines
authors.affiliation: Nova Scotia Breast Screening Program, Halifax, Nova Scotia, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Duggan
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening; D008875:Middle Aged; D009674:Nova Scotia / Q000453:epidemiology; D011247:Pregnancy; D011856:Radiographic Image Enhancement / Q000379:methods
keywords: Breast screening; False-positive rate; Harms of screening; Mammography; Organized screening