title: Breast cancer risk is increased in the years following false-positive breast cancer screening.
abstract: A small number of studies have investigated breast cancer (BC) risk among women with a history of false-positive recall (FPR) in BC screening, but none of them has used time-to-event analysis while at the same time quantifying the effect of false-negative diagnostic assessment (FNDA). FNDA occurs when screening detects BC, but this BC is missed on diagnostic assessment (DA). As a result of FNDA, screenings that detected cancer are incorrectly classified as FPR. Our study linked data recorded in the Flemish BC screening program (women aged 50-69 years) to data from the national cancer registry. We used Cox proportional hazards models on a retrospective cohort of 298 738 women to assess the association between FPR and subsequent BC, while adjusting for potential confounders. The mean follow-up was 6.9 years. Compared with women without recall, women with a history of FPR were at an increased risk of developing BC [hazard ratio=2.10 (95% confidence interval: 1.92-2.31)]. However, 22% of BC after FPR was due to FNDA. The hazard ratio dropped to 1.69 (95% confidence interval: 1.52-1.87) when FNDA was excluded. Women with FPR have a subsequently increased BC risk compared with women without recall. The risk is higher for women who have a FPR BI-RADS 4 or 5 compared with FPR BI-RADS 3. There is room for improvement of diagnostic assessment: 41% of the excess risk is explained by FNDA after baseline screening.
authors.affiliation: aVrije Universiteit Brussel bBelgian Cancer Registry cCentrum voor Kankeropsporing (Center for Cancer Detection) dUniversity Hospital Leuven eGhent University.
authors.forename: Mathijs C
authors.initials: MC
authors.lastname: Goossens
authors.forename: Isabel
authors.initials: I
authors.lastname: De Brabander
authors.forename: Jacques
authors.initials: J
authors.lastname: De Greve
authors.forename: Evelien
authors.initials: E
authors.lastname: Vaes
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Ongeval
authors.forename: Koen
authors.initials: K
authors.lastname: Van Herck
authors.forename: Eliane
authors.initials: E
authors.lastname: Kellen
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D001940:Breast / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D055088:Early Detection of Cancer / Q000009:adverse effects* / Q000379:methods; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000009:adverse effects; D008403:Mass Screening / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors