Cumulative risks of false positive recall and screen‐detected breast cancer after multiple screening examinations

Women tend to make a decision about participation in breast cancer screening and adhere to this for future invitations. Therefore, our study aimed to provide high‐quality information on cumulative risks of false‐positive (FP) recall and screen‐detected breast cancer over multiple screening examinations. Individual Dutch screening registry data (2005‐2018) were gathered on subsequent screening examinations of 92 902 women age 49 to 51 years in 2005. Survival analyses were used to calculate cumulative risks of a FP and a true‐positive (TP) result after seven examinations. Data from 66 472 women age 58 to 59 years were used to extrapolate to 11 examinations. Participation, detection and additional FP rates were calculated for women who previously received FP results compared to women with true negative (TN) results. After 7 examinations, the cumulative risk of a TP result was 3.7% and the cumulative risk of a FP result was 9.1%. After 11 examinations, this increased to 7.1% and 13.5%, respectively. Following a FP result, participation was lower (71%‐81%) than following a TN result (>90%). In women with a FP result, more TP results (factor 1.59 [95% CI: 1.44‐1.72]), more interval cancers (factor 1.66 [95% CI: 1.41‐1.91]) and more FP results (factor 1.96 [95% CI: 1.87‐2.05]) were found than in women with TN results. In conclusion, due to a low recall rate in the Netherlands, the cumulative risk of a FP recall is relatively low, while the cumulative risk of a TP result is comparable. Breast cancer diagnoses and FP results were more common in women with FP results than in women with TN results, while participation was lower. What's new? Population‐based breast cancer screening programmes reduce breast cancer mortality. However, presenting the potential risks over multiple screening examinations is crucial to enable women to make an informed choice about participation. In this breast cancer screening nationwide registry study using 13 years of follow‐up data from the Netherlands, the cumulative risk of a false‐positive recall was relatively low, while the cumulative risk of a true‐positive result was comparable to that in other European countries. The rates of screen‐detected and interval cancers and false‐positives were higher in women who had received false‐positive results than in women with true‐negative results, while their participation was lower.