Increased Risk of Developing Breast Cancer after a False-Positive Screening Mammogram

Abstract

Background Women with a history of false-positive mammogram result may be at increased risk of developing subsequent breast cancer. Methods Using 1994 to 2009 Breast Cancer Surveillance Consortium data we included women ages 40–74 years with a screening mammogram that resulted in a false-positive with recommendation for additional imaging, false-positive with recommendation for biopsy, or true-negative with no cancer within one year following the examination. We used partly conditional Cox proportional hazards survival models to assess the association between a false-positive mammogram result and subsequent breast cancer, adjusting for potential confounders. Adjusted survival curves stratified by breast density and false-positive result were used to evaluate changes in risk over time. Results During 12,022,560 person-years of follow-up, 48,735 cancers were diagnosed. Compared to women with a true-negative examination, women with a false-positive with additional imaging recommendation had increased risk of developing breast cancer (adjusted hazard ratio (aHR)=1.39, 95%CI:1.35–1.44) as did women with a false-positive with a biopsy recommendation (aHR=1.76, 95%CI:1.65–1.88). Results stratifying by breast density were similar to overall results except among women with almost entirely fatty breasts in which aHRs were similar for both false-positive groups. Women with a false-positive result had persistently increased risk of developing breast cancer 10-years after the false-positive examination. Conclusion/Impact Women with a history of a false-positive screening mammogram or biopsy recommendation were at increased risk of developing breast cancer for at least a decade, suggesting that prior false-positive screening may be useful in risk prediction models.

Implications of false‐positive results for future cancer screenings

“…Fifth, previous breast biopsy is a risk factor for future breast cancer diagnosis, suggesting a valid reason for higher future screening rates in some women. A more common situation, repeat breast imaging without biopsy, also may be associated with future breast cancer, although this association has been described only recently and is unlikely to explain the results of the current study. Sixth, the majority of cancer screenings were ordered during routine clinical care, and therefore results may not extend to organized cancer screening programs.…”

A half-second glimpse often lets radiologists identify breast cancer cases even when viewing the mammogram of the opposite breast

“…Performance with these small sections is about what one would expect if the signal were being pooled across the entire image when the entire image is present. This finding may have clinical significance in the light of recent evidence that women with false-positive screening mammograms were at an increased risk of developing breast cancer compared with those with true negatives (31). Perhaps, even if localized signs of cancer were not unambiguously visible at the initial screening, radiologists still may have been influenced by the global signal of abnormality that we are studying here.…”

Extraordinary Claims Don’t always Require Extraordinary Evidence, but They Do Require Good Quality Evidence

“…Specificity for cancer detection is critical as a false diagnosis of cancer could cause physical, financial, and/or emotional harm (Hubbard et al, 2011). Additionally a false cancer diagnosis can actually be associated with increased risk of developing cancer (Henderson et al, 2015). To further explore the authors' claim of 100% sensitivity it appears, from Table 1, that there was also a 100% concordance with cancer staging based on the CTC/ml values which is discordant with other studies (Krebs et al, 2011).…”