"We don’t want women to read this and feel worried," says Louise M. Henderson. "We intend for our findings to be a useful tool in the context of other risk factors and assessing overall breast cancer risk." (Credit: Freddie Peña/Flickr)

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False positive mammograms may flag future cancer

Women with a history of false positive mammogram results may be at increased risk of developing breast cancer for up to 10 years later.

In the United States, 67 percent of women ages 40 and older undergo screening mammography every one to two years. Prior studies have shown that about 16 percent of first mammograms and 10 percent of subsequent mammograms will generate a false positive result.

During the course of 10 screening mammograms, the chance of at least one false positive result is 61 percent for women screened annually, and 42 percent for women screened every two years.

“Our finding that breast cancer risk remains elevated up to 10 years after the false positive result suggests that the radiologist observed suspicious findings on mammograms that are a marker of future cancer risk,” says lead author Louise M. Henderson, assistant professor of radiology at the University of North Carolina School of Medicine.

“Given that the initial result is a false positive, it is possible that the abnormal pattern, while noncancerous, is a radiographic marker associated with subsequent cancer.”

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For this study, published in the journal Cancer Epidemiology, Biomarkers & Prevention, researchers analyzed data from the Breast Cancer Surveillance Consortium (BCSC) from 1994 to 2009. The study population, which came from seven registries in different parts of the United States, included 2.2 million screening mammograms performed in 1.3 million women, ages 40 to 74 years. The Carolina Mammography Registry, a registry that draws on data from imaging facilities across North Carolina and housed at UNC-Chapel Hill, was one of the seven registries included in the study.

After the initial screening, women in the study were tracked across 10 years. During this period, 48,735 women were diagnosed with breast cancer.

After a mammogram, women showing some evidence of suspicious tissue will typically be referred for additional imaging, and some of those women will be further referred for a breast biopsy. After adjusting for common factors that influence breast cancer risk, the researchers found that women whose mammograms were classified as false positive who were referred for additional imaging had a 39 percent increased chance of developing subsequent breast cancer during the 10-year follow-up period, compared with women with a true negative result.

Women whose mammograms were classified as false positive but were referred for a breast biopsy had a 76 percent increased chance of developing subsequent breast cancer compared with women with a true negative result.

The researchers also examined whether breast density affected the relationship between false positive mammograms and subsequent breast cancer.

“A higher proportion of false positive results were present among women with heterogeneously or extremely dense breasts compared with women who had almost entirely fatty breasts or scattered fibroglandular densities,” Henderson says. This was not surprising, as increased breast density is known to make mammograms more difficult to read.

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Breast density did not affect the relationship between false positive mammograms and subsequent cancer for most women.

Recent research has shown that women who experience false positive mammograms tend to feel anxious and may develop negative effects on behavior and sleep. Henderson says she doesn’t want the findings to increase anxiety over mammograms and breast health because the increase in absolute risk with a false positive mammogram result is modest.

“We don’t want women to read this and feel worried,” she says. “We intend for our findings to be a useful tool in the context of other risk factors and assessing overall breast cancer risk.”

Age, race, family history of breast cancer, history of a breast biopsy, and mammographic breast density are also significant factors in determining a woman’s risk in the BCSC risk calculator, Henderson says.

“Our next steps are to consider how to incorporate a prior false-positive mammogram and biopsy results into risk-prediction models for breast cancer.”

The findings are consistent with results from several other countries, including Denmark, Spain, and the United Kingdom. The primary limitation of the study is that women may have moved out of the registry areas while the study was being conducted, in which case they were no longer followed. The researchers also could not assess how many cancers developed from the site of the initial suspicious mammographic finding and how many were missed cancers from a different location, including the other breast.

The BCSC and grants from the National Cancer Institute funded the work. Researchers from the University of Pennsylvania, the University of Vermont, the Group Health Research Institute in Seattle; and the University of California, San Francisco are study coauthors.

Source: UNC-Chapel Hill

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