Can False-Positive Mammograms Be Avoided?

Mammograms have proven to be successful in detecting breast cancer early for many women. In fact, it can be crucial in saving the lives of Black women, who are 40 percent more likely to die from breast cancer than white women. Unfortunately, that annual screening may come with a health scare. Fully half of all women who have annual mammograms to screen for breast cancer will receive a false-positive test result over a decade of screening, according to a new study.

False-positive results call for further testing and eventually rule out cancer. False alarms can certainly increase anxiety.

Can false positives be avoided?

"Women undergoing screening mammography should be aware that being recalled for additional imaging is common and try not to worry," says study author Diana Miglioretti, a professor and division chief of biostatistics at the University of California, Davis. "Most of the time, the additional imaging shows that everything is normal."

For the study, Miglioretti and her colleagues analyzed data from close to 3 million screening mammograms for more than 903,000 women between 40 and 79 years of age. The participants underwent breast cancer screening between 2005 and 2018 at 126 radiology centers.

The study found that the risk of false-positive results is lower in women who are screened every other year.

Yearly screening with newer 3D technology called digital breast tomosynthesis or 3D mammography modestly decreased the odds of a false positive when compared with the standard digital 2D mammography.

Of women who received a false-positive result after an annual 3D mammogram, 17% needed additional imaging, and 11% needed a biopsy to rule out cancer. These numbers were just slightly higher among women screened with digital 2D mammograms.

Older women and women who don't have dense breasts were less likely to get a false-positive result, the study showed.

You can also reduce your risk by making sure to transfer over any old images if you change doctors or facilities so doctors can compare them and better spot any changes.

How often should you get a screening?

There's been an ongoing debate within the medical community about how often women should undergo breast cancer screening.

The U.S. Preventive Services Task Force recommends that women who are at average risk for breast cancer get their first mammogram at age 50, and then every two years until age 74.

Meanwhile, the American Cancer Society says 40- to 44-year-old women should consider annual mammograms. They are recommended for women between 45 and 54 years of age.

"Screening every two years has been found to be effective for most women in terms of detecting cancer early while reducing the harms of screening such as false positives," Miglioretti shares.

Still, she says, guidelines aren't written in stone.

"Some women at higher risk of advanced cancer despite screening might choose to screen annually, for example, postmenopausal women who are obese or taking hormone replacement therapy," Miglioretti adds. "If women are unsure, they should talk with their clinicians about the tradeoffs of annual versus biennial screening."

Being called back after a screening mammogram or ultrasound for additional images or a biopsy should be considered routine, says Dr. Laurie Margolies, chief of breast imaging at Mount Sinai Health System in New York City. She was not part of the study, but reviewed the findings.

"It is not a cause of alarm as most of the time we can clear people with additional images," Margolies notes.

She believes that getting a mammogram every two years instead of yearly is a "major mistake." The new study doesn't look at cancers found by yearly screens compared with screens done every two years.

"People who skip a mammogram often have larger cancers and are really sorry that they didn't come the previous year when the cancer would have been smaller and easier to treat," Margolies adds.

Mammograms aren't perfect, but they are getting better, says Dr. Marisa Weiss, founder and chief medical officer of Breastcancer.org and Breasthealth.org in Ardmore, Pa.

"We still need better methods of early detection that both reduce the risk of a false positive [false alarm] and lower the risk of a false negative [missing a cancer] for all women, especially young women who are more likely to have dense breasts, an inherited high-risk predisposition, and more at stake: young children, growing careers, more years of life at risk," says Weiss.

It's important to do everything in your power to take care of yourself, which includes regular mammogram screening. If you are uncertain of your risks and how often you should be screened, consult with your doctor.

If you are having trouble getting regular mammogram screenings, the following tips may help:

If you're worried about cost, talk to your doctor, a local hospital social worker, or staff members at a mammogram center. Ask about free programs in your area. You can also call the American Cancer Society at 1-800-227-2345 or the National Cancer Institute at 1-800-422-6237 to be directed to lower-cost mammogram centers in your area.
If you're having difficulty scheduling a mammogram at the center where you live, call the American Cancer Society, the National Cancer Institute, or visit the American College of Radiology website’s Accredited Facility Search to find additional certified mammogram providers near you.
If you find mammograms painful, ask the mammography center staff members how the experience can be as easy and as comfortable as possible for you.
Many states require that private insurance companies, Medicaid, and public employee health plans offer coverage for specific health services, including mammograms. The only state without a law ensuring that private health plans cover screening mammograms is Utah.

This information is provided by Breastcancer.org.