Women's compliance with screening standards not impacted by prior false-positive mammograms

Women who have a prior false-positive mammogram are not any less likely to be compliant with screening guidelines than women who have negative mammograms, according to a recent study published by the Journal of the American College of Radiology.

Lara A. Hardesty, MD, department of radiology at the University of Colorado School of Medicine in Aurora, and colleagues reviewed data from more than 9,000 mammograms performed on women 40 years of age or older between December 1, 2012, and December 31, 2013.

The team looked at how the recall status of a woman’s prior mammogram impacted their compliance with screening guidelines, taking into account both American College of Radiology (ACR) guidelines and those put forth by the United States Preventive Services Task Force (USPSTF).

The difference between ACR and USPSTF screening guidelines, of course, is that the ACR recommends annual screening mammography beginning at age 40, and the USPSTF recommends screening every two years between the ages of 50 and 74. (See prior Radiology Business coverage for more information.)

Hardesty et al. explained how they tracked compliance with both sets of guidelines.

“Our breast imaging practice strongly recommends that women follow the ACR screening mammography guidelines, but many of our patients' referring providers advise the women to follow the USPSTF guidelines,” the authors wrote. “Indicator variables for compliance with the ACR’s guidelines and, separately, for compliance with the USPSTF’s guidelines were created based on age and time between mammograms for all nonbaseline screening mammograms. Compliance with ACR guidelines was defined as receipt of a mammogram every year (plus two months to allow for minor scheduling issues) for women 40 years of age or older. Compliance with USPSTF guidelines was defined as receipt of a mammogram every two years (plus two months to allow for minor scheduling issues) for women aged 50-74 years.”

Overall, the researchers found that “there is no association between compliance with screening mammography guidelines and recall status on prior mammogram.”

“Although multiple studies show that false-positive mammograms create anxiety and the USPSTF lists that outcome as a harm of screening mammography, our study demonstrates that, for women who continue to participate in screening mammography, compliance with screening guidelines is not affected by a prior false-positive mammogram,” the authors wrote. “Women previously recalled are neither more nor less likely to be compliant than are women who were not recalled. A false-positive mammogram is not a sufficient deterrent to alter these women’s subsequent screening behavior.”

Hardesty and colleagues noted that their results differed from past investigations, which showed decreases in compliance with guidelines after women had a false-positive mammogram. Those studies were carried out outside of the United States, they said, which could at least partially explain the difference.

“Differences in health care practices and cultural differences between countries may impact women’s perceptions of the risks and benefits of participating in mammographic screening,” the authors wrote.

The data did reveal one significant difference between women who had a prior false-positive mammogram and those who did not: women who had a prior false-positive mammogram were more likely to have their next mammogram at an outpatient office instead of a mobile mammography unit. The authors said the reasoning for this is unknown at this time.

Hardesty and colleagues said their study did have certain limitations. For example, the number of women who had a false-positive mammogram and chose not to go back for further screening could not be properly measured. In addition, the data only covered “insured women in one health system in one metropolitan area,” so results could have been different if some patients had been uninsured or from a different area.