Re-attendance at biennial screening mammography following a repeated false positive recall.

Abstract

We determined the re-attendance rate at screening mammography after a single or a repeated false positive recall and we assessed the effects of transition from screen-film mammography (SFM) to full-field digital mammography (FFDM) on screening outcome in women recalled twice for the same mammographic abnormality. The study population consisted of a consecutive series of 302,912 SFM and 90,288 FFDM screens. During a 2years follow-up period (until the next biennial screen), we collected the breast imaging reports and biopsy results of all recalled women. Re-attendance at biennial screening mammography was 93.2% (95% CI 93.1-93.3%) for women with a negative screen (i.e., no recall at screening mammography), 65.4% (95% CI 64.0-66.8%) for women recalled once, 56.7% (95% CI 47.1-66.4%) for women recalled twice but for different lesions and 44.3% (95% CI 31.4-57.1%) for women recalled twice for the same lesion. FFDM recalls comprised a significantly larger proportion of women who had been recalled twice for the same lesion (1.9% of recalls (52 women) at FFDM vs. 0.9% of recalls (37 women) at SFM, P<0.001) and the positive predictive value of these recalls (PPV) was significantly lower at FFDM (15.4 vs. 35.1%, P=0.03). At review, 20 of 52 women (39.5%, all with benign outcome) would not have been recalled for a second time at FFDM if the previous hard copy SFM screen had been available for comparison. We conclude that a repeated false positive recall for the same lesion significantly lowered the probability of screening re-attendance. The first round of FFDM significantly increased the proportion of women recalled twice for the same lesion, with a significantly lower PPV of these lesions. Almost 40% of repeatedly recalled women would not have been recalled the second time if the previous hard copy SFM screen had been available for comparison at the time of FFDM.