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Ho PJ, Bok CM, Ishak HMM, Lim LY, Liu J, Wong FY, Chia KS, Tan MH, Chay WY, Hartman M, Li J. Factors associated with false-positive mammography at first screen in an Asian population. PLoS One 2019; 14:e0213615. [PMID: 30856210 PMCID: PMC6411141 DOI: 10.1371/journal.pone.0213615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction False-positive recall is an issue in national screening programmes. The aim of this study is to investigate the recall rate at first screen and to identify potential predictors of false-positive recall in a multi-ethnic Asian population-based breast cancer screening programme. Methods Women aged 50–64 years attending screening mammography for the first time (n = 25,318) were included in this study. The associations between potential predictors (sociodemographic, lifestyle and reproductive) and false-positive recall were evaluated using multivariable logistic regression models. Results The recall rate was 7.6% (n = 1,923), of which with 93.8% were false-positive. Factors independently associated with higher false-positive recall included Indian ethnicity (odds ratio [95% confidence interval]: 1.52 [1.25 to 1.84]), premenopause (1.23 [1.04 to 1.44]), nulliparity (1.85 [1.57 to 2.17]), recent breast symptoms (1.72 [1.31 to 2.23]) and history of breast lump excision (1.87 [1.53 to 2.26]). Factors associated with lower risk of false-positive recall included older age at screen (0.84 [0.73 to 0.97]) and use of oral contraceptives (0.87 [0.78 to 0.97]). After further adjustment of percent mammographic density, associations with older age at screening (0.97 [0.84 to 1.11]) and menopausal status (1.12 [0.95 to 1.32]) were attenuated and no longer significant. Conclusion For every breast cancer identified, 15 women without cancer were subjected to further testing. Efforts to educate Asian women on what it means to be recalled will be useful in reducing unnecessary stress and anxiety.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore, Genome, Singapore, Singapore, Singapore
| | - Chek Mei Bok
- Genome Institute of Singapore, Genome, Singapore, Singapore, Singapore
| | | | - Li Yan Lim
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Jenny Liu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | | | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Min-Han Tan
- National Cancer Centre, Singapore, Singapore
- Institute of Bioengineering and Nanotechnology, Singapore, Singapore
| | | | - Mikael Hartman
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore, Genome, Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
- * E-mail:
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Pelletier E, Daigle JM, Defay F, Major D, Guertin MH, Brisson J. Frequency and Determinants of a Short-Interval Follow-up Recommendation After an Abnormal Screening Mammogram. Can Assoc Radiol J 2016; 67:322-329. [PMID: 27209218 DOI: 10.1016/j.carj.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/28/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE After imaging assessment of an abnormal screening mammogram, a follow-up examination 6 months later is recommended to some women. Our aim was to identify which characteristics of lesions, women, and physicians are associated to such short-interval follow-up recommendation in the Quebec Breast Cancer Screening Program. METHODS Between 1998 and 2008, 1,839,396 screening mammograms were performed and a total of 114,781 abnormal screens were assessed by imaging only. Multivariate analysis was done with multilevel Poisson regression models with robust variance and generalized linear mixed models. RESULTS A short-interval follow-up was recommended in 26.7% of assessments with imaging only, representing 2.3% of all screens. Case-mix adjusted proportion of short-interval follow-up recommendations varied substantially across physicians (range: 4%-64%). Radiologists with high recall rates (≥15%) had a high proportion of short-interval follow-up recommendation (risk ratio: 1.82; 95% confidence interval: 1.35-2.45) compared to radiologists with low recall rates (<5%). The adjusted proportion of short-interval follow-up was high (22.8%) even when a previous mammogram was usually available. CONCLUSIONS Short-interval follow-up recommendation at assessment is frequent in this Canadian screening program, even when a previous mammogram is available. Characteristics related to radiologists appear to be key determinants of short-interval follow-up recommendation, rather than characteristics of lesions or patient mix. Given that it can cause anxiety to women and adds pressure on the health system, it appears important to record and report short-interval follow-up and to identify ways to reduce its frequency. Short-interval follow-up recommendations should be considered when assessing the burden of mammography screening.
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Affiliation(s)
- Eric Pelletier
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada.
| | - Jean-Marc Daigle
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada
| | - Fannie Defay
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada
| | - Diane Major
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada
| | - Marie-Hélène Guertin
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada
| | - Jacques Brisson
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada; Centre de recherche du Centre hospitalier universitaire de Québec, Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada
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Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M, Hilton E, Bailey S, Barrett N, Briers P, English R, Jackson A, Kutt E, Lavelle J, Rockall L, Wallis MG, Wilson M, Patnick J. Hormone replacement therapy and false positive recall in the Million Women Study: patterns of use, hormonal constituents and consistency of effect. Breast Cancer Res 2005; 8:R8. [PMID: 16417651 PMCID: PMC1413983 DOI: 10.1186/bcr1364] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Revised: 11/02/2005] [Accepted: 11/08/2005] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Current and recent users of hormone replacement therapy (HRT) have an increased risk of being recalled to assessment at mammography without breast cancer being diagnosed ('false positive recall'), but there is limited information on the effects of different patterns of HRT use on this. The aim of this study is to investigate in detail the relationship between patterns of use of HRT and false positive recall. METHODS A total of 87,967 postmenopausal women aged 50 to 64 years attending routine breast cancer screening at 10 UK National Health Service Breast Screening Units from 1996 to 1998 joined the Million Women Study by completing a questionnaire before screening and were followed for their screening outcome. RESULTS Overall, 399 (0.5%) participants were diagnosed with breast cancer and 2,629 (3.0%) had false positive recall. Compared to never users of HRT, the adjusted relative risk (95% CI) of false positive recall was: 1.62 (1.43-1.83), 1.80 (1.62-2.01) and 0.76 (0.52-1.10) in current users of oestrogen-only HRT, oestrogen-progestagen HRT and tibolone, respectively (p (heterogeneity) < 0.0001); 1.65 (1.43-1.91), 1.49 (1.22-1.81) and 2.11 (1.45-3.07) for current HRT used orally, transdermally or via an implant, respectively (p (heterogeneity) = 0.2); and 1.84 (1.67-2.04) and 1.75 (1.49-2.06) for sequential and continuous oestrogen-progestagen HRT, respectively (p (heterogeneity) = 0.6). The relative risk of false positive recall among current users appeared to increase with increasing time since menopause, but did not vary significantly according to any other factors examined, including duration of use, hormonal constituents, dose, whether single- or two-view screening was used, or the woman's personal characteristics. CONCLUSION Current use of oestrogen-only and oestrogen-progestagen HRT, but not tibolone, increases the risk of false positive recall at screening.
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Affiliation(s)
- Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia
| | - Gillian Reeves
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Valerie Beral
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Diana Bull
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Barbara Crossley
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Moya Simmonds
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Elizabeth Hilton
- Cancer Research UK Epidemiology Unit, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Stephen Bailey
- Breast Screening Service, Princess of Wales Community Hospital, Stourbridge Road, Bromsgrove B61 0BB, UK
| | - Nigel Barrett
- West of London Breast Screening Service, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Peter Briers
- Gloucestershire Breast Screening Service, Linton House, Thirlestaine Road, Cheltenham, Glos GL53 7AS, UK
| | - Ruth English
- The Breast Care Unit, Oxford Radcliffe Hospital NHS Trust, The Churchill Hospital, Old Road, Headington, Oxford OX3 7JH, UK
| | - Alan Jackson
- Patricia Massey Breast Screening Unit, Queen Alexandra Hospital, Cosham, Portsmouth, Hants PO6 3LY, UK
| | - Elizabeth Kutt
- Avon Breast Screening, Central Health Clinic, Tower Hill, Bristol BS2 0JD, UK
| | - Janet Lavelle
- North Lancashire Breast Screening Service, Royal Lancaster Infirmary, Ashton Court, Lancaster LA1 4GG, UK
| | - Linda Rockall
- The West Sussex Breast Screening Service, Worthing Hospital, Park Avenue, Worthing, West Sussex BN11 2DH, UK
| | - Matthew G Wallis
- Breast Screening Unit, Coventry and Warwick Hospital, Stoney Stanton Road, Coventry CV1 4FH, UK
| | - Mary Wilson
- Greater Manchester Breast Screening Service, The Nightingale Centre, Withington Hospital, Nell Lane, Manchester M20 0PT, UK
| | - Julietta Patnick
- National Health Service Cancer Screening Programmes, Fulwood House, Old Fulwood Road, Sheffield S10 3TH, UK
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Banks E, Reeves G, Beral V, Bull D, Crossley B, Simmonds M, Hilton E, Bailey S, Barrett N, Briers P, English R, Jackson A, Kutt E, Lavelle J, Rockall L, Wallis MG, Wilson M, Patnick J. Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the Million Women Study: cohort study. BMJ 2004; 329:477. [PMID: 15331472 PMCID: PMC515195 DOI: 10.1136/bmj.329.7464.477] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine how lifestyle, hormonal, and other factors influence the sensitivity and specificity of mammography. METHODS Women recruited into the Million Women Study completed a questionnaire about various personal factors before routine mammographic screening. A sample of 122,355 women aged 50-64 years were followed for outcome of screening and incident breast cancer in the next 12 months. Sensitivity and specificity were calculated by using standard definitions, with adjustment for potential confounding factors. RESULTS Breast cancer was diagnosed in 726 (0.6%) women, 629 in screen positive and 97 in screen negative women; 3885 (3.2%) were screen positive but had no subsequent diagnosis of breast cancer. Overall sensitivity was 86.6% and specificity was 96.8%. Three factors had an adverse effect on both measures: use of hormone replacement therapy (sensitivity: 83.0% (95% confidence interval 77.4% to 87.6%), 84.7% (73.9% to 91.6%), and 92.1% (87.6% to 95.0%); specificity: 96.8% (96.6% to 97.0%), 97.8% (97.5% to 98.0%), and 98.1% (98.0% to 98.2%), respectively, for current, past, and never use); previous breast surgery v no previous breast surgery (sensitivity: 83.5% (75.7% to 89.1%) v 89.4% (86.5% to 91.8%); specificity: 96.2% (95.8% to 96.5%) v 97.4% (97.3% to 97.5%), respectively); and body mass index < 25 v > or = 25 (sensitivity: 85.7% (81.2% to 89.3%) v 91.0% (87.5% to 93.6%); specificity: 97.2% (97.0% to 97.3%) v 97.4% (97.3% to 97.6%), respectively). Neither sensitivity nor specificity varied significantly according to age, family history of breast cancer, parity, past oral contraceptive use, tubal ligation, physical activity, smoking, or alcohol consumption. CONCLUSIONS The efficiency, and possibly the effectiveness, of mammographic screening is lower in users of hormone replacement therapy, in women with previous breast surgery, and in thin women compared with other women.
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Affiliation(s)
- Emily Banks
- Cancer Research UK Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE.
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