Factors Associated with False Positive Results on Screening Mammography in a Population of Predominantly Hispanic Women

Abstract

Potential harms of screening mammography include false positive results, such as recall breast imaging or biopsies. We recruited women undergoing screening mammography at Columbia University Medical Center in New York, New York. They completed a questionnaire on breast cancer risk factors and permitted access to their medical records. Breast cancer risk status was determined using the Gail model and a family history screener. High risk was defined as a 5-year invasive breast cancer risk of ≥1.67% or eligible for genetic testing. False positive results were defined as recall breast imaging (BIRADS score of 0, 3, 4, or 5) and/or biopsies that did not yield breast cancer. From November 2014 to October 2015, 2,361 women were enrolled and 2,019 were evaluable, of whom 76% were Hispanic and 10% non-Hispanic white. Fewer Hispanic women met high-risk criteria for breast cancer than non-Hispanic whites (18.0% vs. 68.1%), but Hispanics more frequently engaged in annual screening (71.9% vs. 60.8%). Higher breast density (heterogeneously/extremely dense vs. mostly fat/scattered fibroglandular densities) and more frequent screening (annual vs. biennial) were significantly associated with false positive results [odds ratio (OR), 1.64; 95% confidence interval (CI), 1.32-2.04 and OR, 2.18; 95% CI, 1.70-2.80, respectively]. We observed that women who screened more frequently or had higher breast density were at greater risk for false positive results. In addition, Hispanic women were screening more frequently despite having a lower risk of breast cancer compared with whites. Our results highlight the need for risk-stratified screening to potentially minimize the harms of screening mammography. .

The Challenges of Screening Mammography in Racial/Ethnic Minority Populations in the United States: A mini-review and observations from a predominantly Hispanic community

“…We sought to investigate the rates of false positive mammography results in this predominantly minority, Hispanic population, as well as factors associated with higher rates of false positive results, for the reasons previously detailed. We found that among the largely Hispanic (70%) population of women presenting for screening mammography at the Avon Breast Imaging Center at CUMC and agreeing to participate in our study, approximately 53% of women had at least one false positive result on their screening mammograms over a median of 8.9 years of screening (range, 0–26) 43 . The factors associated with false positive results were similar to those of more predominantly white, non-minority populations, namely, frequency of screening and increased breast density.…”

Identifying Women at High Risk for Breast Cancer Using Data From the Electronic Health Record Compared With Self-Report

“…27 However, these updated guidelines have not had a significant impact on changing mammography screening practices. 18,28 A recent publication found that risk-stratified breast cancer screening was cost-effective with a favorable benefit-toharm ratio using a life-table model, and there are ongoing prospective studies in the United States testing this hypothesis. 29 If systematic breast cancer risk assessment can be incorporated into clinic workflow and included in the patient's medical record (ie, incorporated into the mammography report), this may help identify women with low to average risk who may benefit from less frequent routine screening and women with high risk who may be eligible for more intensive supplemental screening (ie, breast ultrasound or magnetic resonance imaging).…”

“…We enrolled women undergoing screening mammography in the Know Your Risk: Assessment at Screening (KYRAS) survey study. 18 After providing informed consent, all participants completed a baseline self-administered questionnaire in English or Spanish. We collected information on demographics and breast cancer risk factors.…”

“…org/10.1200/CCI. 18. 00072 age, race/ethnicity, first-degree family history of breast cancer, previous benign breast biopsy (including nonproliferative lesions, proliferative changes with or without atypia, and LCIS), and mammographic density.…”

Uptake of genetic testing for germline BRCA1/2 pathogenic variants in a predominantly Hispanic population

“…We conducted a prospective study called the Know Your Risk: Assessment at Screening (KYRAS) [19]. Women were approached for enrollment during routine screening mammography at the Avon Breast Imaging Center at Columbia University Irving Medical Center (CUIMC) in the Washington Heights neighborhood of New York, NY, and provided written informed consent to complete a baseline survey and to allow access to their electronic health record (EHR).…”