• Diana L Miglioretti, Linn Abraham, Brian L Sprague, Christoph I Lee, Michael C S Bissell, Thao-Quyen H Ho, BowlesErin J AEJA0000-0001-6287-7391Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington (L.A., E.J.A.B.)., Louise M Henderson, Rebecca A Hubbard, TostesonAnna N AANA0000-0001-7718-8943The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Dartmouth Cancer Center, Lebanon, New Hampshire (A.N.A.T.)., and Karla Kerlikowske.
• Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California, and Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington (D.L.M.).
• Ann. Intern. Med. 2024 Oct 1; 177 (10): 129713071297-1307.

BackgroundFalse-positive results on screening mammography may affect women's willingness to return for future screening.ObjectiveTo evaluate the association between screening mammography results and the probability of subsequent screening.DesignCohort study.Setting177 facilities participating in the Breast Cancer Surveillance Consortium (BCSC).Patients3 529 825 screening mammograms (3 184 482 true negatives and 345 343 false positives) performed from 2005 to 2017 among 1 053 672 women aged 40 to 73 years without a breast cancer diagnosis.MeasurementsMammography results (true-negative result or false-positive recall with a recommendation for immediate additional imaging only, short-interval follow-up, or biopsy) from 1 or 2 screening mammograms. Absolute differences in the probability of returning for screening within 9 to 30 months of false-positive versus true-negative screening results were estimated, adjusting for race, ethnicity, age, time since last mammogram, BCSC registry, and clustering within women and facilities.ResultsWomen were more likely to return after a true-negative result (76.9% [95% CI, 75.1% to 78.6%]) than after a false-positive recall for additional imaging only (adjusted absolute difference, -1.9 percentage points [CI, -3.1 to -0.7 percentage points]), short-interval follow-up (-15.9 percentage points [CI, -19.7 to -12.0 percentage points]), or biopsy (-10.0 percentage points [CI, -14.2 to -5.9 percentage points]). Asian and Hispanic/Latinx women had the largest decreases in the probability of returning after a false positive with a recommendation for short-interval follow-up (-20 to -25 percentage points) or biopsy (-13 to -14 percentage points) versus a true negative. Among women with 2 screening mammograms within 5 years, a false-positive result on the second was associated with a decreased probability of returning for a third regardless of the first screening result.LimitationWomen could receive care at non-BCSC facilities.ConclusionWomen were less likely to return to screening after false-positive mammography results, especially with recommendations for short-interval follow-up or biopsy, raising concerns about continued participation in routine screening among these women at increased breast cancer risk.Primary Funding SourceNational Cancer Institute.

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