Surrounded by “pink ribbon everything”, women naturally experience more anxiety with breast cancer screening than nearly any other imaging exam, particularly if the patient has had friends or family members affected with breast cancer. One’s history of previous false-positive callbacks also affects screening anxiety 1and women who receive a false-positive callback exam are more likely to delay their next screening exam 2.

Furthermore, these women are at a higher risk for finding a future malignancy, simply by having a prior false-positive screening mammogram or prior biopsy recommendation 3.  A careful discussion between the physician and patient must consider the additional screening benefits for finding a few more cancers per 1,000 patients screened, at the risks of:

  • Additional imaging findings recommended for biopsy;
  • Additional radiation exposure (with low risk for radiation-induced malignancy);  
  • Risks of intravenous contrast dye for Contrast-Enhanced Digital Mammography (CEDM),  Magnetic Resonance Imaging (MRI), Molecular Breast Imaging (MBI); and,
  • Increased out-of-pocket costs  

No protocol guideline can estimate a patient’s personal fears, concerns, or anxiety

For example, a patient may be willing to undergo additional systemic radiation exposure and high out-of-pocket costs with MBI in order to have a high level of reassurance that the breast tissue is normal.  Another patient may feel the possible finding of an early breast cancer outweighs the risks and negatives of undergoing a benign biopsy. Alternatively, yet another patient may happily assume the risks of her extremely dense breast tissue and not undergo further screening tests (although she is now aware of her elevated risk and will need to do be more diligent about any breast changes).

With this information and scenarios, women may decide, with their physicians, what more (if anything) they need to do about it:  Genetic testing, Ultrasound, MRI, Contrast-enhanced Digital Mammography (CEDM), MBI, chemoprevention (a scary word that means “anti-estrogen” pills), risk-lowering lifestyle changes, and close observation.  

The goal is to detect any developing breast cancer as early as possible, when it most likely is treatable and  96-99 percent curable when detected at an early stage.  However, undergoing more screening, because it is available, is not necessarily ideal unless there is a warranted risk or anxiety.

Learn more how you can advocate for your own breast health and quality of care here.  

References

1 Bolejko A, Hagell P, Wann-Hansson C, Zackrisson S. Cancer Epidemiol Biomarkers Prev. August 26, 2015.

2 Dabbous FM, Dolecek TA, Berbaum, Friedewald SM, Summerfelt WT, Hoskins K, Rauscher GH. Impact of a False-Positive Screening Mammogram on Subsequent Screening Behavior and Stage at Breast Cancer Diagnosis. Cancer Epidemiol Biomarkers Prev. February 9, 2017.

3 Henderson LM, Hubbard RA, Sprague BL, Zhu W, Kerlikowske K.  Increased Risk of Developing Breast Cancer after a False-Positive Screening Mammogram.  Cancer Epidemiol Biomarkers Prev. 2015 Dec;24(12):1882-9.