Cumulative Probability of False-Positive Results After 10 Years of Screening With Digital Breast Tomosynthesis vs Digital Mammography
New BCSC study estimates half of all women experience false positive mammograms after 10 years of annual screening
In a new BCSC study published in JAMA Network Open, researchers analyzed 3 million screening mammograms from 903,495 women aged 40–79 years from 2005 to 2018 at 126 radiology facilities. The study found that the probability of receiving at least one false positive result over a 10-year period was, at best, only modestly lower on digital breast tomosynthesis also known as (“3D mammography”) vs. digital mammography (“2D mammography”) but biennial screening interval, older age, and non-dense breasts were more strongly associated with lower false-positive probabilities than screening modality. For example, with annual tomosynthesis screening, 50% of women will experience at least one false positive recall, 17% a false positive short-interval follow-up recommendation, and 11% a false positive biopsy recommendation compared to 56% of women screened with 2D digital mammograms having a false positive recall, 18% a short-interval follow-up recommendation, and 12% a biopsy recommendation. However, screening every other year showed a considerably lower probability of at least one false positive result over ten years of screening than annual mammograms for both 3D and 2D mammography. False positive recalls are estimated to occur in 50% of women receiving annual 3D mammograms but in only 36% of those screened every two years. For short-interval follow-up recommendations, 17% of women undergoing annual 3D mammography are estimated to have at least one false positive over 10 years, compared to just 10% of those undergoing biennial screening. False positive benign biopsy recommendations are estimated to occur in 11% of women receiving annual 3D mammograms but in only 7% of those screened every two years. False positives were also substantially lower in older vs younger age groups (e.g., for annual tomosynthesis screening in women ages 70-79 vs 40-49, recall = 39.8 vs 60.8; short-interval follow-up = 13.3 vs 20.7; and biopsy recommendation = 9.1 vs 13.2) and among women with entirely fatty vs extremely dense breasts (e.g., for annual tomosynthesis screening in women aged 50-59 years, recall = 29.1 vs 60.4; short-interval follow-up = 8.9 vs 19.8; and biopsy recommendation = 4.9 vs 15.1).
Findings from the study highlight the importance of patient-provider discussions around personalized health. It is important to consider a patient’s preferences and risk factors when deciding on screening interval and modality. An associated commentary by Dr. Lydia Pace, MD, MPH stresses the importance for clinicians to continue counseling patients about false-positive results from mammography, especially women who choose to be screened every year or to start screening before age 50 years.
Ho TH, Bissell MCS, Kerlikowske K, Hubbard RA, Sprague BL, Lee CI, Tice JA, Tosteson ANA, Miglioretti DL. Cumulative Probability of False-Positive Results After 10 Years of Screening With Digital Breast Tomosynthesis vs Digital Mammography. JAMA Netw Open. 2022;5(3):e222440. doi:10.1001/jamanetworkopen.2022.2440 [Link]
The research study was covered by over 100 websites and news sources (web-based, TV, and radio), with a potential reach of more than 522 million viewers. Twitter reach exceeded 327,000. A few examples of media stories are below:
Weekend Today (NBC)
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News Channel 6 This Morning (Wichita)
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Posted by: Diana Miglioretti