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Long-term risk of screen-detected and interval breast cancer after false-positive results at mammography screening: joint analysis of three national cohorts

British Journal of Cancervolume 120pages269275 (2019) | Download Citation



We assessed the long-term risk of screen-detected and interval breast cancer in women with a first or second false-positive screening result.


Joint analysis had been performed using individual-level data from three population-based screening programs in Europe (Copenhagen in Denmark, Norway, and Spain). Overall, 75,513 screened women aged 50–69 years from Denmark (1991–2010), 556,640 from Norway (1996–2008), and 517,314 from Spain (1994–2010) were included. We used partly conditional Cox hazards models to assess the association between false-positive results and the risk of subsequent screen-detected and interval cancer.


During follow-up, 1,149,467 women underwent 3,510,450 screening exams, and 10,623 screen-detected and 5700 interval cancers were diagnosed. Compared to women with negative tests, those with false-positive results had a two-fold risk of screen-detected (HR = 2.04, 95% CI: 1.93–2.16) and interval cancer (HR = 2.18, 95% CI: 2.02–2.34). Women with a second false-positive result had over a four-fold risk of screen-detected and interval cancer (HR = 4.71, 95% CI: 3.81–5.83 and HR = 4.22, 95% CI: 3.27–5.46, respectively). Women remained at an elevated risk for 12 years after the false-positive result.


Women with prior false-positive results had an increased risk of screen-detected and interval cancer for over a decade. This information should be considered to design personalised screening strategies based on individual risk.

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The authors would like to thank the Benign Lesion (BELE) Study Group (Spain); Walter Schwartz, Mammography Screening Clinic, University Hospital Odense, Denmark; Ilse Vejborg, Diagnostic Imaging Centre, Copenhagen University Hospital, Copenhagen, Denmark; the staff at the breast centres at BreastScreen Norway. This work had no specific funding source.

Author contributions

M.R., S.H., M.vE., and X.C. conceived the study and participated in its design. M.R., S.H., and M.vE. collected and checked the information recorded by the screening centres, and performed the extraction and validation of their data. M.R. merged and structured the analysis database, and performed the statistical analysis. The results were circulated and commented on by all the authors. M.R. drafted the first version, and it was critically reviewed by M.vE., S.H., and X.C. All authors read and approved the final manuscript.

Author information


  1. Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    • Marta Román
    •  & Xavier Castells
  2. Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain

    • Marta Román
    •  & Xavier Castells
  3. Department of Screening, Cancer Registry of Norway, Oslo, Norway

    • Solveig Hofvind
  4. Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway

    • Solveig Hofvind
  5. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    • My von Euler-Chelpin


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Ethics approval and consent to participate

Data on screening results in Copenhagen were retrieved from the Copenhagen Mammography Register. Cancer Data on breast cancers were supplied by the Danish Cancer Registry and the Danish Breast Cancer Cooperative Group. Approval for data analysis was granted by the Danish Data Inspection Agency. Data from Norway was provided by the Cancer Registry of Norway. Collection of screening data follows the regulations of the institution and no ethical committee approval was necessary since all data used were anonymised. Screening data from Spain were obtained from the databases of the screening centres. The Review Boards of the institutions that provided data gave approval for data analyses.

Competing interests

The authors declare no competing interests.


This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

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Correspondence to Marta Román.

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