Effect of Previous Benign Breast Biopsy on the Interpretive Performance of Subsequent Screening Mammography

Effect of Previous Benign Breast Biopsy on the Interpretive Performance of Subsequent Screening Mammography
Stephen H. Taplin, L. Abraham, B. M. Geller, B. C. Yankaskas, D. S. M. Buist, R. Smith-Bindman, C. Lehman, D. Weaver, P. A. Carney, and W. E. Barlow
JNCI 2010 102;14:1-12

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Most breast biopsies will be negative for cancer. Benign breast biopsy can cause changes in the breast tissue, but whether such changes affect the interpretive performance of future screening mammography is not known

The reduced accuracy reported in this study is clinically important, regardless of whether the biopsy caused the differences, because this will help clinicians inform women about the potential adverse effects of benign biopsy. Our results showed that the unadjusted specificity was reduced by 2.3 percentage points. After adjustment for women's characteristics, evidence of reduced specificity and reduced PPV2 was statistically significant.  These differences in specificity mean additional imaging evaluations and potentially more biopsies among women with a benign biopsy history, but our findings regarding sensitivity make it seem unlikely that more cancers were subsequently missed.

Thus, our results could be used to prepare women with a history of a previous benign biopsy when they are being referred for their next mammogram. Although a woman with a previous benign biopsy is more likely to have cancer than someone without such a history, it can also be noted that she has a higher risk of a false-positive screening mammogram. The message before the next mammogram for a woman with a benign biopsy history should be that a positive test must be taken seriously, but there is also a good chance of a false-positive test. Furthermore, it is not likely to affect subsequent cancer detection. Whether this mitigates anxiety at the time of a referral should be studied further because persistent anxiety is the principal long-term consequence of a false-positive mammogram