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Long-term Risk of False-Positive Screening Results and Subsequent Biopsy as a Function of Mammography Use¹

¹ From the Departments of Surgery (K.B., J.A.C., K.S.H., B.L.S., K.K.T., J.S.M.), Pathology (J.S.M.), and Radiology (D.B.K., R.M., E.F.H.), Massachusetts General Hospital, Yawkey 7939, 55 Fruit St, Boston, MA 02114; and Departments of Pathology (J.S.M.), Surgery (K.S.H., B.L.S., K.K.T.), and Radiology (D.B.K., E.F.H.), Harvard Medical School, Boston, Mass. Received January 21, 2005; revision requested March 23; revision received May 18; accepted June 21; final version accepted November 2. Supported by departmental funds from the Massachusetts General Hospital Division of Surgical Oncology. Address correspondence to J.S.M. (e-mail: michaelj{at}helix.mgh.harvard.edu).

View larger version (33K): [in a new window]   Figure 1: Ten-year rates for biopsies that did not reveal cancer (black bars) compared with those for biopsies that did reveal cancer (white bars) in women with negative screening results in 1991 (see Table 1 for values). The number of women who underwent biopsies that did not reveal cancer declined from 57 women per 1000 mammograms for those who underwent one mammographic procedure to nine women per 1000 mammograms for those who underwent 10 mammographic procedures. While a small reduction might be expected due to simple random sampling without replacement, which would be expected to have reduced the number from 57 women per 1000 mammograms to 44 women per 1000 mammograms, the actual reduction to nine women far exceeds this value.

View larger version (22K): [in a new window]   Figure 2: Graph demonstrates a reduction over time in the occurrence of biopsies that did not reveal cancer in women who underwent regular screening. The incidence of biopsies that did not reveal cancer is shown as a function of the amount of time since the patients' screening mammogram in 1993 for women who promptly returned each year for the next 7 years.

View larger version (37K): [in a new window]   Figure 3a: (a, b) Ten-year rates for false-positive mammographic assessments in women who received a negative screening result in 1991 (see Table 1 for values). Note that, in a, the decline in the occurrence of false-positive assessments with increased screening use (as was the case for biopsies that did not reveal cancer) is greater than would be expected for simple random sampling without replacement.

View larger version (35K): [in a new window]   Figure 3b: (a, b) Ten-year rates for false-positive mammographic assessments in women who received a negative screening result in 1991 (see Table 1 for values). Note that, in a, the decline in the occurrence of false-positive assessments with increased screening use (as was the case for biopsies that did not reveal cancer) is greater than would be expected for simple random sampling without replacement.