Top PDF Impact of false positive mammography on subsequent screening attendance and risk of cancer

Impact of false positive mammography on subsequent screening attendance and risk of cancer

Impact of false positive mammography on subsequent screening attendance and risk of cancer

The current findings relate to women assessed at first screen within the East Anglia screening programme, carried out over the period 1989–1995. With technical improvements to the programme and women’s increased familiarity with it, reduced reattendance and increased risk of cancer may be less associated with false-positive mam- mography at first screen. Furthermore, the impact of false- positive mammography may be lower after a second or subsequent screening. Fewer women are assessed at second and subsequent screens [37,38], possibly due to the increase in specificity associated with the availability of previous films for comparison [39]. Finally, it should be noted that, while there was increased risk of subsequent cancer associated with women assessed at first screen, such women contributed only a modest proportion of all interval and second round screen-detected cancers.
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Breast cancer detection risk in screening mammography after a false-positive result

Breast cancer detection risk in screening mammography after a false-positive result

We analyzed information from a wide retrospective cohort over a 17-year period, which enabled us to ascertain the risk over a series of sequential screening participations. The wide spectrum of information analyzed – integrating information from several radiology units with different screening protocols – strengthens the consistency of the associations found, indepen- dently of possible differences in screening practice or the period analyzed. Moreover, the associations found were observed after adjustment was made for possible confounders, and in the stratified analysis. Nevertheless, our study also has some limitations. We performed specific analyses to outline possible causes for the association studied, which suggested some possible underlying reasons. Further studies are required to confirm the suggested hypothesis. No information was available on breast density, which could be associated with both an increased false-positive risk and an increased breast cancer risk.
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Longitudinal study of the influence of false-positive mammography results on psychological outcomes and subsequent screening behavior

Longitudinal study of the influence of false-positive mammography results on psychological outcomes and subsequent screening behavior

11 Persistence of psychological outcomes after a false-positive test result Implicit in the proposed model is the assumption that psychological effects of false-positive mammograms, such as worry, anxiety and perceptions of risk, are persistent. That is, the model requires that psychological effects after false-positive test results persist long enough to motivate or deter subsequent mammography screening, which in the U.S. is typically recommended 1 year after the test that produced the false-positive result. 61, 62, 87 One explanation for this phenomenon is that people may have considerable difficulty revising their beliefs once they are formed. This is true even when presented with credible information contrary to those beliefs. 63, 64 In the context of mammography screening, abnormal test results might cause women to believe they have an underlying medical problem. Upon learning they do not have cancer, some women may have difficulty undoing thoughts of worry, anxiety and susceptibility to disease elicited by the abnormal test results.
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An audit to investigate the impact of false positive breast screening results and diagnostic work up on re engagement with subsequent routine screening

An audit to investigate the impact of false positive breast screening results and diagnostic work up on re engagement with subsequent routine screening

In this study 75% of the false positive women referred to the assessment clinic received an imaging- only intervention. The numbers referred for breast biopsy are compliant with NHSBSP (2010) guidance which states that approximately 1% of women screened will undergo a needle biopsy [14]. Those women undergoing breast biopsy procedures in this study were more likely to return to future screening than those undergoing minimally invasive assessment (17.5% compared to 7%). While caution should be shown because numbers of women in each category are small, this local finding is in opposition to the findings of the large-scale Fitzpatrick et al study (biopsy candidates less likely to attend) [11] and Signeurin et al (no effect of diagnostic work-up on attendance) [10]. We propose that although biopsy procedures are potentially more distressing and require a longer anxious wait for results, this delay in receiving results may in fact work in the woman’s favour, offering them more time to consider their situation, seek support from family members, and ask pertinent questions of health care staff at their follow-up visit one week later. This ‘continuum of care’ may leave women with a positive perception of the breast screening unit.
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An audit to investigate the impact of false positive breast screening results and diagnostic work up on re engagement with subsequent routine screening

An audit to investigate the impact of false positive breast screening results and diagnostic work up on re engagement with subsequent routine screening

In this study 75% of the false positive women referred to the assessment clinic received an imaging- only intervention. The numbers referred for breast biopsy are compliant with NHSBSP (2010) guidance which states that approximately 1% of women screened will undergo a needle biopsy [14]. Those women undergoing breast biopsy procedures in this study were more likely to return to future screening than those undergoing minimally invasive assessment (17.5% compared to 7%). While caution should be shown because numbers of women in each category are small, this local finding is in opposition to the findings of the large-scale Fitzpatrick et al study (biopsy candidates less likely to attend) [11] and Signeurin et al (no effect of diagnostic work-up on attendance) [10]. We propose that although biopsy procedures are potentially more distressing and require a longer anxious wait for results, this delay in receiving results may in fact work in the woman’s favour, offering them more time to consider their situation, seek support from family members, and ask pertinent questions of health care staff at their follow-up visit one week later. This ‘continuum of care’ may leave women with a positive perception of the breast screening unit.
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Not all false positive diagnoses are equal: On the prognostic implications of false positive diagnoses made in breast MRI versus in mammography / digital tomosynthesis screening

Not all false positive diagnoses are equal: On the prognostic implications of false positive diagnoses made in breast MRI versus in mammography / digital tomosynthesis screening

low-grade DCIS [23, 53, 54]. Accordingly, we propose a careful discussion on what constitutes a true-positive vs. a “false-positive” diagnosis in women at average risk who undergo screening for breast cancer. If it is agreeable that a true-positive diag- nosis should be one that has an impact on a woman’s further management (i.e., an “actionable” diagnosis), then diagnosis of atypical tissue changes could indeed be considered a true-positive diagnosis. Most practice guidelines recommend intensified surveillance, prevent- ive surgery, or even chemoprevention for women with a tissue diagnosis of ADH, ALH, or LIN [26–29]. Regard- less of how we label false-positive imaging diagnoses, breast radiologists should be aware of the fact that not all false-positive diagnoses are equal in that not all are only unwanted side effects of the desire to establish a diagnosis of breast cancer early, but many, especially many false-positive MRI diagnoses, provide valuable in- formation that is helpful for guiding further patient management. Last, but especially important, we suggest that this information be given to women with dense breasts when they are counseled about the advantages and disadvantages of different supplemental breast cancer screening methods.
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Cost effectiveness of MRI compared to mammography for breast cancer screening in a high risk population

Cost effectiveness of MRI compared to mammography for breast cancer screening in a high risk population

Our study has some limitations that must be addressed. There are additional issues relevant to the management of women at high-risk for breast cancer that were not incor- porated in the model, and may influence the cost-effec- tiveness of screening with MRI. For example, although BRCA mutation carriers may choose to undergo prophy- lactic mastectomy, many do not choose this option, with estimates ranging from 0% to 54% of carriers [11,26]. Fur- thermore, some of the women are also at increased risk for ovarian cancer. The costs of radiation exposure due to annual mammography starting at an earlier age were not incorporated, nor were the costs of possible anxiety and stress from unnecessary biopsies stemming from false positive MRI screening. Any or all of these factors might alter the cost-effectiveness estimate. Finally, the results of our model should be interpreted with care given that the results of this cost-effectiveness analysis require compari- sons to data from observational studies, the Surveillance, Epidemiology and End Results Program, or clinical trials.
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A method for calculating effective lifetime risk of radiation induced cancer from screening mammography

A method for calculating effective lifetime risk of radiation induced cancer from screening mammography

(0.67) Discussion The objective of screening mammography is to detect breast cancer early when treatment and recovery are more likely to be successful. However, since the introduction of screening mammography there has been great debate about the risks versus benefits. In this context, Jin (2014) 37 reported the possible disadvantages of screening mammography, other than the radiation risk. These drawbacks were: firstly, the false negative which is mammography’s inability to detect all breast cancers; secondly, mammography false positive (wrong diagnosis) which results in time wasted in extra examinations and undesired anxiety; thirdly, over diagnosis, the treatment of low risk breast cancers which would not cause health problems.
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Systematic review of 3D mammography for breast cancer screening.

Systematic review of 3D mammography for breast cancer screening.

as an unknown number of cases in this arm may have been dis- missed during arbitration based on DBT information. Despite this bias, the higher number of cancers detected with DBT þ FFDM resulted in the positive predictive value of DBT þ FFDM being similar to that of FFDM alone. Evidence from the European studies is currently insuf fi cient to establish the exact impact of DBT on recall and false positives after consensus reading due to the lack of prospective blinded consensus reading in both large studies.

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Systematic review of 3D mammography for breast cancer screening

Systematic review of 3D mammography for breast cancer screening

as an unknown number of cases in this arm may have been dis- missed during arbitration based on DBT information. Despite this bias, the higher number of cancers detected with DBT þ FFDM resulted in the positive predictive value of DBT þ FFDM being similar to that of FFDM alone. Evidence from the European studies is currently insuf ficient to establish the exact impact of DBT on recall and false positives after consensus reading due to the lack of prospective blinded consensus reading in both large studies.

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Self-Reported Health Status, Perceived Risk for Developing Breast Cancer, and Mammography Screening Use

Self-Reported Health Status, Perceived Risk for Developing Breast Cancer, and Mammography Screening Use

Healthy People 2020 (2016b) outlines national health-related goals, in which one of the objectives has been the reduction in the number of new cancer cases. Another goal of Healthy people 2020 was a reduction in illness, disability, and death associated with cancer. The Healthy People 2020 goal for the reduction in the number of new cancer cases may be accomplished by assessing how women report their health and rate their perceived risk for developing breast cancer. In this research study, I sought to promote positive social change by studying the impact that self-reported health status may have on a woman’s perceived risk for developing breast cancer. In this chapter, I discuss the problem statement surrounding self-reported health status and perceived breast cancer risk, the purpose of the research study, the research questions and their associated hypotheses, and the foundations of the theoretical framework in which the research was grounded in. Other sections in this chapter include a discussion on the nature of the study, definitions of terms used throughout the dissertation, assumptions regarding the research study, scope and delimitations, limitations, and a discussion about the significance of the research study.
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Symptoms and risk of breast cancer : a population-based cohort study within the Finnish mammography screening programme

Symptoms and risk of breast cancer : a population-based cohort study within the Finnish mammography screening programme

This study was limited to those women who attended screening and the size of breast tumors was generally small. Thus, the sensitivity and specificity of diagnosing breast tumors based on symptoms were limited. Also, breast cancer cases detected outside screening were not included. It may be that women with symptoms also had other risk factors (like dense breasts or positive family history) which might con- found the observed effect. A potential limitation of this cross- sectional study is the lack of descriptive information other than age so no adjustment for confounders such as breast den- sity, family history of breast cancer or number of previous screens was possible in the multivariate analysis. The study was cross-sectional and no follow-up or subsequent round of screening was included. There was a possibility that knowing the symptom status may have already influenced the radiology result. Given the low sensitivity of symptoms in our study it is likely that a prevention program based on clinical examination would not provide sufficient benefit for breast cancer control in Finland and the mammography screening program is still justified. The study provides limited evidence that reporting symptoms at screen was associated with aggressive tumors, i.e., tumors with poor prognosis. This study cannot say about the impact in low resource setting with currently no breast cancer screening services. However, considering the higher risk of breast cancer in women with symptoms, clinical breast examination together with the availability of diagnostic serv- ices could help in detecting large size tumors. Importance of breast cancer symptoms in the cancer prevention and control strategy needs to be evaluated also in other settings.
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American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography

American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography

It is reasonable to extrapolate that detection of noninvasive (DCIS) and small invasive cancers will lead to mortality benefit. The guideline recommendations for MRI screening as an adjunct to mammography for women at increased risk of breast cancer take into account the available evidence on efficacy and effectiveness of MRI screening, estimates of level of risk for women in various categories based on both family history and clinical fac- tors, and expert consensus opinion where evi- dence for certain risk groups is lacking. All of these groups of women should be offered clin- ical trials of MRI screening, if available. Women should be informed about the benefits, limita- tions, and potential harms of MRI screening, including the likelihood of false-positive find- ings. Recommendations are conditional on an acceptable level of quality of MRI screening, which should be performed by experienced providers in facilities that provide MRI-guided biopsy for the follow up of any suspicious results.
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Risk of radiation induced cancer from screening mammography

Risk of radiation induced cancer from screening mammography

3.2 The Origins of Mammography Imaging – Equipment and Rudiments of Technique Concerns about breast disease were reported long before the discovery of X-rays (Wentz & Parsons, 1997). The first reported attempt to use X-rays for breast tissue imaging was by Salamon, a German surgeon, in 1913. He imaged 3000 mastectomy specimens observing the close correlation between the radiographic and pathologic abnormalities of breast tissue under investigation. He also described the radiographic appearance of malignant breast lesions. However, mammography only began being performed on patients from the mid to late 1920s in Europe, the United States, and South America where it helped to explain many breast abnormalities (Vyborny & Schmidt, 1989). The radiographic appearance of benign breast lesions and their distinctive features over breast carcinomas were reported by Walter Vogel (1931, as cited in Gold, Bassett, & Widoff, 1990). In the same year, Seabold (1931) documented his findings about breast disease detected by radiography. Work by Gershon- Cohen and Strickler (1938) described the normal radiographic appearances of breast tissue at different ages and across a range of menstrual conditions. The diagnostic information available from early mammograms was restricted due to technical limitations of the mammography equipment available in this period. This compelled many researchers to use different contrast agents such as gases for pneumocystography or iodinated compounds for ductography. Many studies reported the adverse effects of such contrast agents (Romano &
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Estimating the cumulative risk of false positive cancer screenings

Estimating the cumulative risk of false positive cancer screenings

where α age(1) = 0 because we have constant term α 0 . The data are a table of counts for age categories cross-classified by FP outcome (yes or no). See supplemental file. The second logistic regression models the probability of FP on a screening after the first as a function of age at screening, time since the last screening, the number of the screening, and whether or not there was a previous FP. To obtain a parsimonious model we have made two simpli- fications. First we use screening number rather than chronological time. For example, in one subject screening might occur at times 0, 1, and 3, and in another subject, screening might occur at times 0, 1, 2. In terms of the model, both subjects have three screenings indexed by t = 1, 2, 3. This has the advantage of reducing the number of missing-data patterns as there are, by definition, no miss- ing "between" screenings. To model various patterns of missingness would require a much more complicated for- mulation, which is not warranted given the sparse data. To account for different intervals between screenings we included time since the previous screenings as a covariate (which parallels the GW formulation). Our second sim- plification is using an indicator of previous FP rather than a more detailed history of FP because there are too few data to adequately fit a model that conditions on various prior patterns of FP.
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Changes in cancer detection and false-positive recall in mammography using artificial intelligence: a retrospective, multireader study

Changes in cancer detection and false-positive recall in mammography using artificial intelligence: a retrospective, multireader study

INSIGHT MMG) provides four-view heatmaps and an abnormality score per breast (ie, the maximum of the craniocaudal and mediolateral oblique abnormality scores) for each input mammogram (figure 2). Details of the algorithm are specified in the appendix (p 4). Validation of AI-based diagnostic support software We used the per-mammogram abnormality score—ie, the maximum of abnormality scores of each of the four- views—to evaluate AI standalone performance, including area under the receiver operating characteristic (ROC) curve (AUROC), sensitivity, and specificity. The cutoff threshold between 0 and 1 for measuring sensitivity and specificity was set to 0·1 to achieve 90% sensitivity in the tuning dataset, and this threshold was also used for validation and the reader study. AI standalone performance was evaluated with three validation datasets from different countries: South Korea (619 cancer-positive, 620 benign, and 619 normal mammo grams), the USA (250 cancer- positive, 250 benign, and 250 normal mammograms), and the UK (218 cancer-positive, 218 benign, and 218 normal mammograms; figure 1). To explore how multinational, large-scale datasets affect the performance of AI, we also trained the same AI algorithm using just the South Korea dataset (ie, single nationality) and with subsets of the South Korea dataset (ie, a smaller scale in terms of cancer). Reader study
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The False-Positive in Universal Newborn Hearing Screening

The False-Positive in Universal Newborn Hearing Screening

However, support for UNHS is not universal. One of the most concerning issues raised is the high rate of false-positive results. The literature reports false- positive rates between 3% and 8%. 5,7–11 This has caused a number of critics to decline to recommend UNHS until the false-positive rate can be decreased and/or there is further knowledge of the emotional effect this false-positive labeling has on families. 12–14 A number of studies from other newborn-screening tests have shown that false-positive results can en- gender lasting anxiety and adversely affect the par- ent– child relationship. 15–18 In addition, deUzcategiu and Yoshinga-Itano 19 surveyed mothers immediately after their children had failed the newborn hearing screen and found that 20% to 50% of mothers re- ported feelings, such as anger, confusion, depression, frustration, shock, and sadness. However, it is still unknown how persistent or detrimental these feel- ings are.
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Mathematical modelling of radiation induced cancer risk from breast screening by mammography

Mathematical modelling of radiation induced cancer risk from breast screening by mammography

mammography was considered as 75 years in all of our scenarios. The graph comprises of three lines, one for each time interval, so it can be easily used to evaluate the total effective risk of any screening programme by the commencement age of screening using interpolation method. The main advantage of our graphical data is that they represent an easy way for radiation risk estimation from screening mammography to be illustrated. The graph can be simply used by clinicians/referrers or practitioners, and the graphical data are more likely to be understandable by the women than MGD. It is useful for screening mammography justification in terms of harms versus benefits especially for high breast cancer risk women who are invited for early and more frequent screening mammography than average breast cancer risk women. Moreover, the radiation risk to other body tissues and organs are included in this model.
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Breast Cancer Subtypes and Screening Mammography Sensitivity

Breast Cancer Subtypes and Screening Mammography Sensitivity

Screening sensitivity may also vary according to tumour aggressiveness. Aggressive cancers progress rapidly through the preclinical phase, therefore, narrowing the window of opportunity to detect them, before they become symptomatic. Conversely, non-aggressive cancers progress slowly (low grade (I)) through the preclinical phase and so, there is greater opportunity to detect them. Tumour receptor status and grade have been extensively studied in the past and generally suggest that ER-positive and PR-positive tumours are more frequently grade I than grade 3 tumours. These findings concur with more recent studies of this subject. 38-40 The association of HER2 with grade has been less studied and is less consistent than ER and PR although some suggest HER2-positive tumours are more frequently high grade. 38,40-42 Molecular studies revealed that the four subtypes varied in the expression of aggressive genes such as MKI67, CCNB1, and MYBL2 which are known to be associated with cellular proliferation. 3,10 Studies examining the association between subtype and grade reporting both crude and adjusted results were consistent 7,21,38,43-53 with few disagreeing studies and suggested that compared to Luminal A, Basal-like and HER2- enriched subtypes were strongly associated with high-grade. An association between Luminal B and higher grade was also reported in one study. 45
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Attendance in cancer screening programmes in Italy

Attendance in cancer screening programmes in Italy

The Centre for Disease Control and Prevention at the Italian Ministry of Health entrusted the Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute (CNESPS) of Italian National Health Institute (Istituto Superiore di Sanità, ISS), and the PROFEA (PROgramma di Formazione in Epidemiologia Applicata) with the task of developing a system for continuous surveillance over the adult population (PASSI – Progessi delle Aziende Sanitarie per la Salute in Italia). The aim of PASSI study is to estimate the frequency and evolution of behavioural risk factors for health and the diffusion of preventive measures in the Italian population. Passi is based on phone interviews carried out through a standardized questionnaire from a sample of people aged 18-69 years, randomly recruited from the Local Health Units’ lists. All Italian regions participated to the study, with a total number of 123 Local Health Units involved in the data collection.
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