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Effect of false-positives and women’s characteristics on long-term adherence to breast cancer screening

  • Epidemiology
  • Published:
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Abstract

False-positive results may influence adherence to mammography screening. The effectiveness of breast cancer screening is closely related to adequate adherence among the target population. The objective of this study was to evaluate how false-positives and women’s characteristics affect the likelihood of reattendance at routine breast cancer screening in a sequence of routine screening invitations. We performed a retrospective cohort study of 1,371,218 women aged 45–69 years, eligible for the next routine screening, who underwent 4,545,346 screening mammograms from 1990 to 2006. We estimated the likelihood of attendance at seven sequential screening mammograms. Multilevel discrete time hazard models were used to estimate the effect of false-positive results on reattendance, and the odds ratios (OR) of non-attendance for the women’s personal characteristics studied. The overall reattendance rate at the second screening was 81.7% while at the seventh screening was 95.6%. At the second screening invitation reattendance among women with and without a false-positive mammogram was 79.3 vs. 85.3%, respectively. At the fourth and seventh screenings, these percentages were 86.3 vs. 89.9% and 94.6 vs. 96.0%, respectively. The study variables associated with a higher risk of failing to participate in subsequent screenings were oldest age (OR = 8.48; 95% CI: 8.31–8.65), not attending their first screening invitation (OR = 1.12; 95% CI: 1.11–1.14), and previous invasive procedures (OR = 1.09; 95% CI: 1.07–1.10). The risk of non-attendance was lower in women with a familial history of breast cancer (OR = 0.97; 95% CI: 0.96–0.99), and those using hormone replacement therapy (OR = 0.96; 95% CI: 0.94–0.97). In conclusion, reattendance was lower in women with false-positive mammograms than in those with negative results, although this difference decreased with the number of completed screening participations, suggesting that abnormal results in earlier screenings more strongly influence behavior. These findings may be useful in providing women with accurate information and in improving the effectiveness of screening programs.

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Acknowledgments

This study was founded by grants from the Instituto de Salud Carlos III FEDER (PI09/90251). The funding sources had no role in the performance of the study or in the preparation of the manuscript. The authors would like to thank the entire Cumulative False Positive Risk Group for their support and dedication to this study.

Conflicts of interest

The authors have declared no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Evaluation, Institut Municipal d’Investigació Mèdica-Parc de Salut Mar., Mar Teaching Hospital, 25-29 Passeig Marítim, 08003, Barcelona, Spain

    R. Román, M. Sala & X. Castells

  2. Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública – CIBERESP), Barcelona, Spain

    R. Román, M. Sala, N. Ascunce & X. Castells

  3. Dirección General de Programas Asistenciales, Consejería de Sanidad, Servicio Canario de Salud, Canary Islands, Spain

    M. De La Vega

  4. Program & Analysis Unit, Health Office, Asturias, Spain

    C. Natal

  5. Foundation Society for Cancer Research and Prevention, Pere Virgili Health Research Institute, Reus, Tarragona, Spain

    J. Galceran

  6. Castilla-Leon Breast Cancer Screening Programme, Dirección General de Salud Pública ID e I, SACYL, Castilla y León, Spain

    I. González-Román

  7. La Rioja Breast Cancer Screening Programme, Fundacion Rioja Salud, Logroño, Spain

    A. Baroja

  8. Galician Breast Cancer Screening Programme, Public Health & Planning Directorate, Health Office, Santiago de Compostela, Spain

    R. Zubizarreta

  9. Navarra Breast Cancer Screening Programme, Public Health Institute, Pamplona, Spain

    N. Ascunce

  10. General Directorate Public Health & Centre for Public Health Research, (CSISP), Valencia, Spain

    D. Salas

  11. Universitat Autònoma de Barcelona, Barcelona, Spain

    X. Castells

Authors
  1. R. Román
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  2. M. Sala
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  3. M. De La Vega
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  4. C. Natal
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  5. J. Galceran
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  6. I. González-Román
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  7. A. Baroja
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  8. R. Zubizarreta
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  9. N. Ascunce
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  10. D. Salas
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  11. X. Castells
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Corresponding author

Correspondence to X. Castells.

Additional information

The Members of the “The Cumulative False Positive Risk Group” are given in Appendix.

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Appendix

Appendix

The Cumulative False Positive Risk Group (alphabetical order): Department of Epidemiology and Evaluation, Institut Municipal d’Investigació Mèdica-Parc de Salut Mar, Barcelona: Xavier Castells, Francesc Macià, Cristiane Murta, Rubén Román, María Sala. Galician breast cancer screening programme. Public health & Planning Directorate. Health Office, Galicia: Raquel Almazán, Ana Belén Fernández, María Teresa Queiro, Raquel Zubizarreta. Navarra Breast Cancer Screening Programme. Public Health Institute, Pamplona: Nieves Ascunce, Iosu Delfrade, María Ederra, Nieves Erdozain, Juana Vidan. General Directorate Public Health & Centre for Public Health Research (CSISP), Valencia: Josefa Ibáñez, Dolores Salas. Valencian Health Agency & Centre for Public Health Research (CSISP), Valencia: Dolores Cuevas. Servicio Canario de la Salud, Canary Islands: María Obdulia De la Vega, Isabel Díez de la Lastra. Foundation Society for Cancer Research and Prevention. Pere Virgili Health Research Institute, Reus, Tarragona: Jaume Galceran. Program & Analysis Unit. Health Office, Asturias: Carmen Natal. La Rioja Breast Cancer Screening Programme. Fundacion Rioja Salud, Logroño: Araceli Baroja. Jefa de la Sección de Promoción y Protección de la Salud. Cancer Screening and Epidemiology Department, UDIAT-CD. Corporació Parc Taulí-Institut Universitari Parc Taulı (UAB), Sabadell: Marisa Baré. Castilla-Leon Breast Cancer Screening Programme. Dirección General de Salud Pública ID e I. SACYL, Castilla y León: Isabel González-Román.

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Román, R., Sala, M., De La Vega, M. et al. Effect of false-positives and women’s characteristics on long-term adherence to breast cancer screening. Breast Cancer Res Treat 130, 543–552 (2011). https://doi.org/10.1007/s10549-011-1581-4

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  • DOI: https://doi.org/10.1007/s10549-011-1581-4

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