Ten-Year Risk of False Positive Screening Mammograms and Clinical Breast Examinations
Joann G. Elmore, M.D., M.P.H., Mary B. Barton, M.D., M.P.P., Victoria M. Moceri, Ph.C., Sarah Polk, B.A., Philip J. Arena, M.D., and Suzanne W. Fletcher, M.D.
Background The cumulative risk of a false positive result ofa breast-cancer screening test is unknown.
Methods We performed a 10-year retrospective cohort study ofbreast-cancer screening and diagnostic evaluations among 2400women who were 40 to 69 years old at study entry. Mammogramsor clinical breast examinations that were interpreted as indeterminate,aroused a suspicion of cancer, or prompted recommendations foradditional workup in women in whom breast cancer was not diagnosedwithin the next year were considered to be false positive tests.
Results A total of 9762 screening mammograms and 10,905 screeningclinical breast examinations were performed, for a median of4 mammograms and 5 clinical breast examinations per woman overthe 10-year period. Of the women who were screened, 23.8 percenthad at least one false positive mammogram, 13.4 percent hadat least one false positive breast examination, and 31.7 percenthad at least one false positive result for either test. Theestimated cumulative risk of a false positive result was 49.1percent (95 percent confidence interval, 40.3 to 64.1 percent)after 10 mammograms and 22.3 percent (95 percent confidenceinterval, 19.2 to 27.5 percent) after 10 clinical breast examinations.The false positive tests led to 870 outpatient appointments,539 diagnostic mammograms, 186 ultrasound examinations, 188biopsies, and 1 hospitalization. We estimate that among womenwho do not have breast cancer, 18.6 percent (95 percent confidenceinterval, 9.8 to 41.2 percent) will undergo a biopsy after 10mammograms, and 6.2 percent (95 percent confidence interval,3.7 to 11.2 percent) after 10 clinical breast examinations.For every $100 spent for screening, an additional $33 was spentto evaluate the false positive results.
Conclusions Over 10 years, one third of the women screened hadabnormal test results requiring additional evaluation, eventhough no breast cancer was present. Techniques are needed todecrease false positive results while maintaining high sensitivity.Physicians should educate women about the risk of a false positiveresult of a screening test for breast cancer.
Source Information
From the Departments of Medicine (J.G.E.) and Epidemiology (J.G.E., V.M.M.), University of Washington School of Medicine, Seattle; and the Departments of Ambulatory Care and Prevention (M.B.B., S.P., S.W.F.) and Diagnostic Radiology (P.J.A.), Harvard Pilgrim Health Care and Harvard Medical School, Boston. Presented in part at the national meeting of the Society of General Internal Medicine, Washington, D.C., May 1–3, 1997.
Address reprint requests to Dr. Elmore at the Division of General Internal Medicine, University of Washington School of Medicine, 1959 N.E. Pacific, Rm. BB527E, Box 356429, Seattle, WA 98195-6429.
False Positive Rate of Screening Mammography
Olivotto I. A., Kan L., Coldman A. J., Paci E., Giorgi D., del Turco M. R., Roux S., Markle L., Diamond A., Sickles E. A., Fishbein M., Gross T. L., Kopans D. B., Feig S. A., Elmore J. G., Barton M. B., Arena P. J., Sox H. C.
Extract |
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N Engl J Med 1998;
339:560-564, Aug 20, 1998.
Correspondence
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