8 NEWS
5 MINUTES * 1,2
8 NEWS
8 DECEMBER 2023 ausdoc . com . au
False positive ‘ ups cancer risk ’
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Carmel Sparke WOMEN who receive a false-positive mammography result are 61 % more likely to develop breast cancer over the next 20 years than women without a false positive , Swedish researchers report .
Their population-based study also suggests a 7 % and 84 % increased risk of all-cause death and breast cancer death , respectively , following a false-positive result .
“ These findings can be used to develop individualised risk-based
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breast cancer screening after a false-positive result ,” the authors reported in JAMA Oncology .
They identified 45,000 women ( median age 52 ) with an initial false-positive mammography result from 1991 to 2017 , plus 450,000 matched controls who had also undergone screening .
The 20-year cumulative incidence of breast cancer was 11.3 % in women with a false positive versus 7.3 % in controls , which translated into a 61 % higher breast cancer risk in those
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who were recalled . The risk was highest in the first four years following a false-positive result , as well as among women aged 60-75 and those with lower breast density , the authors said .
“ This study suggests that breast cancer awareness should be emphasised long term for women with a false-positive mammography result .” In other findings , cancers were more commonly detected on the ipsilateral side of the false-positive result , and there was a higher risk of large tumours ( ≥20mm ).
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The researchers said their findings could be a result of “ small tumours being missed at the previous mammography or to proliferative benign disease among women with a false-positive result ”.
“ Alternatively , a false-positive result may serve as an indicator of a generally higher risk of breast cancer .”
Women with false positives were also less likely to return to their next screening , which could affect their risk , the authors said . JAMA Oncol 2023 ; 2 Nov .
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Dialling a diagnosis
FROM PAGE 1 Almost 95 % of GP telehealth consultations in 2021 / 22 used phone rather than video , according to the RACGP ’ s analysis of Medicare data .
The college has cited Professor Glasziou ’ s research as it campaigns against the government ’ s stance that video is superior to phone .
“ Diagnosis of acute conditions … can clearly be more difficult over the telephone ,” says Professor Glasziou , director of the Institute for Evidence-Based Healthcare at Queensland ’ s Bond University .
“ But there is the old adage that about 80 % of diagnosis is done by history , and there are a few reasonable studies that support that .
“ The upshot would be that telehealth is probably adequate , just as good as faceto-face or video , for the vast majority of GP consultations .”
It is a “ subset ” of consultations that require physical examinations , he says .
As part of their research , Professor Glasziou and his colleagues compared phone , video and face-to-face consults for osteoarthritis , insomnia , smoking cessation , chronic conditions and mental health psychotherapy .
He also co-authored a 2023 review of 16 controlled trials that found no differences in clinical effectiveness , patient satisfaction or cost-effectiveness between phone and video for managing patients with established conditions .
A good next step would be research into what makes a high-quality telehealth consult , he says .
“ If we ’ re going to allow telehealth , we need to get better at learning how to do physical examinations or substitutes for it .
“ For example , can you get somebody else to reliably look down [ the patient ’ s ] throat ? Can you guide the person to feel their own lymph nodes ?” See letters , page 15