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The impact of false positive breast cancer screening mammograms on screening retention: A retrospective population cohort study in Alberta, Canada

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Abstract

OBJECTIVES: The impact of false positives on breast cancer screening retention is inconsistent across international studies. We investigate factors associated with screening retention, including false positive screening results, invasiveness of diagnostic procedures, and geographic variation in Alberta, Canada.

METHODS: A total of 213 867 women aged 50–67 years who had an index screen mammogram between July 2006 and June 2008 were evaluated at 30 months post index screen to determine the screening retention rate. The association of screening retention with invasiveness of the diagnostic procedure, time to diagnostic resolution, and region of residence were investigated using multivariable log binomial regression, adjusting for women’s age.

RESULTS: Women with false positive screening results were less likely to return for their next recommended screening than those with a true negative result (62.0% vs. 68.7%). Compared to women with normal screening results, the adjusted risk ratios of fail-to-rescreen for women with imaging-only follow-up, needle sampling, and open biopsy were 1.08 (95% CI: 1.05–1.12), 1.72 (95% CI: 1.44–2.07) and 2.29 (95% CI: 2.09–2.50) respectively. Screening retention rates were slightly higher for rural residents than urban residents. Time to diagnostic resolution was not associated with screening retention. Screening retention peaked at one year from the index date of the previous screening.

CONCLUSION: Higher awareness of the strong negative impact that biopsies in the case of a false positive screening have on screening retention is needed. Such awareness can inform intervention strategies to mitigate the impact and improve screening retention rate.

Résumé

OBJECTIFS: L’incidence des faux positifs sur la fidélisation au dépistage du cancer du sein varie dans les études internationales. Nous étudions les facteurs associés à la fidélisation au dépistage en Alberta, au Canada, dont les résultats faux positifs au dépistage, le caractère invasif de la méthode diagnostique et la variation spatiale.

MÉTHODE: En tout, 213 867 femmes de 50 à 67 ans ayant subi une mammographie de dépistage indicielle entre juillet 2006 et juin 2008 ont été évaluées 30 mois après pour déterminer le taux de fidélisation au dépistage. Les associations entre la fidélisation au dépistage et le caractère invasif de la méthode diagnostique, le délai de résolution du diagnostic et la région de résidence ont été étudiées par régression log-binomiale multivariée avec ajustement en fonction de l’âge des femmes.

RÉSULTATS: Les femmes ayant obtenu des résultats faux positifs au dépistage étaient moins susceptibles de retourner subir leur prochain dépistage recommandé que celles ayant obtenu des résultats vrais négatifs (62,0 % c. 68,7 %). Comparativement aux femmes ayant obtenu des résultats normaux au dépistage, les risques relatifs ajustés des femmes n’ayant pas subi un dépistage ultérieur étaient de 1,08 (IC de 95 %: 1,05–1,12) pour le suivi avec imagerie seulement, de 1,72 (IC de 95 %: 1,44–2,07) pour le prélèvement à l’aide d’une aiguille et de 2,29 (IC de 95 %: 2,09–2,50) pour la biopsie ouverte. Les taux de fidélisation au dépistage étaient légèrement plus élevés chez les résidentes des zones rurales que chez celles des zones urbaines. Le délai de résolution du diagnostic n’était pas associé à la fidélisation au dépistage. La fidélisation au dépistage a culminé un an après la date indicielle du dépistage précédent.

CONCLUSION: Il est nécessaire d’être plus sensibilisé à l’effet très nuisible des biopsies sur la fidélisation au dépistage en cas de résultats faux positifs. Une telle sensibilisation peut éclairer les stratégies d’intervention pour atténuer cet effet et améliorer les taux de fidélisation au dépistage.

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Authors and Affiliations

  1. School of Public Health, University of Alberta, Edmonton, AB, Canada, 3-299 Edmonton Clinic Health Academy, 11405 - 87 Avenue, T6G 1C9

    Ye Shen MPH & Yan Yuan PhD

  2. School of Medicine, Stanford University, Stanford, CA, USA

    Marcy Winget PhD

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  1. Ye Shen MPH
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  2. Marcy Winget PhD
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  3. Yan Yuan PhD
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Correspondence to Yan Yuan PhD.

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Conflict of Interest: None to declare.

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Shen, Y., Winget, M. & Yuan, Y. The impact of false positive breast cancer screening mammograms on screening retention: A retrospective population cohort study in Alberta, Canada. Can J Public Health 108, e539–e545 (2017). https://doi.org/10.17269/CJPH.108.6154

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  • DOI: https://doi.org/10.17269/CJPH.108.6154

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