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False positive readings for 50% of 3D mammograms over a decade of screening

Half of all women getting 3D mammograms will experience a false positive over a decade of annual screening, according to a study published in JAMA Network Open.

False positives – when a mammogram is flagged as abnormal, but there is no cancer – have always been a problem. But 3D mammography has been aggressively marketed by hospitals, doctors and some patient groups for its ability to provide higher image quality images, and previous studies have found they result in fewer false positives, reports Axios Vitals.

In this study, researchers found that over 10 years of getting 3D mammograms, 50% of women will experience at least one false-positive recall compared with 56% of women screened with 2D digital mammograms.

“Whenever you’re called back for an additional workup, it’s very stressful because women think they may have cancer,” Diana Miglioretti, a lead author and professor and division chief of biostatistics at the University of California (UC) Davis Department of Public Health Sciences, told Axios.

“Often it may take days to even weeks to get that resolved,” she said. “The main thing is we want to alleviate women’s anxiety over these false positives and understand they are very common.”

Beyond the anxiety caused by false positives, there are additional out-of-pocket costs for the follow-up diagnostic workups that can be problematic, Miglioretti pointed out.

It’s still a work in progress, but researchers are working on AI that might better identify cancers in mammograms.

Miglioretti’s team is studying the risk factors for getting called back for more imaging.

“If we can identify women, like younger women, women with dense breasts at higher risk of being recalled, we can have the radiologist read the mammogram while she waits so that she can get any additional workup that day. That greatly reduces women’s anxiety because they don’t get this call saying, ‘We need you to come in for additional imaging’,” she said.

Study details
Cumulative probability of false-positive results after 10 years of screening with digital breast tomosynthesis vs digital mammography

Thao-Quyen Ho, Michael Bissell, Karla Kerlikowske, Rebecca Hubbard, Brian Sprague, Christoph Lee, Jeffrey Tice, Anna Tosteson, Diana Miglioretti.

Published in JAMA Open Network on 25 March 2022

Key Points
Question Is there a difference between screening with digital breast tomosynthesis vs digital mammography in the probability of false-positive results after 10 years of screening?
Findings In this comparative effectiveness study of 903 495 individuals undergoing 2 969 055 screening examinations, the 10-year cumulative probability of receiving at least 1 false-positive recall was 6.7% lower for tomosynthesis vs digital mammography with annual screening and 2.4% lower for tomosynthesis vs digital mammography with biennial screening, a significant difference.
Meaning The findings of this study suggest that digital breast tomosynthesis is associated with a lower cumulative probability of false-positive results compared with digital mammography; biennial vs annual screening was associated with larger reductions in cumulative false-positive risk for both modalities.

Abstract

Importance
Breast cancer screening with digital breast tomosynthesis may decrease false-positive results compared with digital mammography.

Objective
To estimate the probability of receiving at least 1 false-positive result after 10 years of screening with digital breast tomosynthesis vs digital mammography in the US.

Design, Setting, and Participants
An observational comparative effectiveness study with data collected prospectively for screening examinations was performed between January 1, 2005, and December 31, 2018, at 126 radiology facilities in the Breast Cancer Surveillance Consortium. Analysis included 903 495 individuals aged 40 to 79 years. Data analysis was conducted from February 9 to September 7, 2021.

Exposures
Screening modality, screening interval, age, and Breast Imaging Reporting and Data System breast density.

Main Outcomes and Measures
Cumulative risk of at least 1 false-positive recall for further imaging, short-interval follow-up recommendation, and biopsy recommendation after 10 years of annual or biennial screening with digital breast tomosynthesis vs digital mammography, accounting for competing risks of breast cancer diagnosis and death.

Results
In this study of 903 495 women, 2 969 055 nonbaseline screening examinations were performed with interpretation by 699 radiologists. Mean (SD) age of the women at the time of the screening examinations was 57.6 (9.9) years, and 58% of the examinations were in individuals younger than 60 years and 46% were performed in women with dense breasts. A total of 15% of examinations used tomosynthesis. For annual screening, the 10-year cumulative probability of at least 1 false-positive result was significantly lower with tomosynthesis vs digital mammography for all outcomes: 49.6% vs 56.3% (difference, –6.7; 95% CI, –7.4 to –6.1) for recall, 16.6% vs 17.8% (difference, –1.1; 95% CI, –1.7 to –0.6) for short-interval follow-up recommendation, and 11.2% vs 11.7% (difference, –0.5; 95% CI, –1.0 to –0.1) for biopsy recommendation. For biennial screening, the cumulative probability of a false-positive recall was significantly lower for tomosynthesis vs digital mammography (35.7% vs 38.1%; difference, –2.4; 95% CI, –3.4 to –1.5), but cumulative probabilities did not differ significantly by modality for short-interval follow-up recommendation (10.3% vs 10.5%; difference, –0.1; 95% CI, –0.7 to 0.5) or biopsy recommendation (6.6% vs 6.7%; difference, –0.1; 95% CI, –0.5 to 0.4). Decreases in cumulative probabilities of false-positive results with tomosynthesis vs digital mammography were largest for annual screening in women with nondense breasts (differences for recall, –6.5 to –12.8; short-interval follow-up, 0.1 to –5.2; and biopsy recommendation, –0.5 to –3.1). Regardless of modality, cumulative probabilities of false-positive results were substantially lower for biennial vs annual screening (overall recall, 35.7 to 38.1 vs 49.6 to 56.3; short-interval follow-up, 10.3 to 10.5 vs 16.6 to 17.8; and biopsy recommendation, 6.6 to 6.7 vs 11.2 to 11.7); older vs younger age groups (eg, among annual screening in women ages 70-79 vs 40-49, recall, 39.8 to 47.0 vs 60.8 to 68.0; short-interval follow-up, 13.3 to 14.2 vs 20.7 to 20.9; and biopsy recommendation, 9.1 to 9.3 vs 13.2 to 13.4); and women with entirely fatty vs extremely dense breasts (eg, among annual screening in women aged 50-59 years, recall, 29.1 to 36.3 vs 58.8 to 60.4; short-interval follow-up, 8.9 to 11.6 vs 19.5 to 19.8; and biopsy recommendation, 4.9 to 8.0 vs 15.1 to 15.3).

Conclusions and Relevance
In this comparative effectiveness study, 10-year cumulative probabilities of false-positive results were lower on digital breast tomosynthesis vs digital mammography. Biennial screening interval, older age, and nondense breasts were associated with larger reductions in false-positive probabilities than screening modality.

 

JAMA Network Open article – Cumulative probability of false-positive results after 10 years of screening with digital breast tomosynthesis vs digital mammography (Open access)

 

Axios Vitals article – Half of women will get a false positive 3D mammogram, study finds (Open access)

 

See more from MedicalBrief archives:

 

3D mammograms detect more invasive breast cancers

 

Google Health using AI to improve breast cancer screening

 

False positive mammogram result may be a clue to later disease

 

KZN Health snubs NGO offer of free mobile mammography

 

Joburg hospital gets international accreditation in breast MRI

 

 

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