Managing False-Positive Screening Results & Anxiety

This page is for anyone whose screening test flagged something that turned out not to be cancer, or who is waiting to find out. It explains how common false positives are, why callbacks happen, and how to cope with the follow-up.

A screening test is a sorting step, not a diagnosis. NCI says a screening test alone cannot diagnose cancer. It shows that something is abnormal, and more tests are needed. A false-positive result means the test flagged something, and the tests that followed showed it was not cancer.

NCI says a false positive can cause anxiety. It is usually followed by more tests and procedures, which carry their own risks.

The numbers are larger than most people expect.

• Mammography, recall for more imaging. Among women screened every year for 10 years, the chance of at least one false-positive recall is 49.6% with 3-D mammography (digital breast tomosynthesis). It is 56.3% with standard 2-D mammography. With screening every other year, the figures are 35.7% and 38.1%.
• Mammography, biopsy. With yearly screening, the 10-year chance of a biopsy recommendation that does not find cancer is 11.2% with 3-D and 11.7% with 2-D. With screening every other year, it is 6.6% and 6.7%.
• Callbacks. ACS says fewer than 1 in 10 women called back for more tests are found to have cancer.
• Lung CT screening. In an analysis of the National Lung Screening Trial, the false-positive rate at the first scan was 26.6%. When the newer Lung-RADS system was applied after the fact, it was 12.8%. Sensitivity also fell, from 93.5% to 84.9%.

False positives are more common when you are younger and when your breast tissue is dense. NCI also lists earlier breast biopsies, a family history of breast cancer, and estrogen use. ACS says callbacks are more common after a first mammogram, or when there are no earlier mammograms to compare.

ACS lists these common reasons:

• The pictures were not clear, or did not show some of your breast tissue.
• The radiologist saw something suspicious, such as calcifications or a mass.
• The radiologist saw an area that looks different from the rest of the breast.

Sometimes more pictures of an area, or more compression, show that it no longer looks suspicious. ACS says the extra images most often show the finding is not cancer. A callback is a request for more information. It is not a diagnosis.

ACS says you will likely have a diagnostic mammogram, with more pictures of the area. You might also have an ultrasound. You will most likely get the results during the visit. Then one of three things usually follows:

• The area is nothing to worry about, and you return to your normal schedule.
• The area is probably nothing to worry about, but your next imaging comes sooner than normal, usually in about 6 months.
• The area could be cancer, so you need a biopsy to know for sure.

A biopsy is the only way to know for sure. ACS says most biopsy results are not cancer. Each step adds a wait, and waiting has its own costs in time, travel and childcare.

USPSTF lists anxiety and breast cancer-specific worry as harms of false-positive results. ACS says it is normal to worry or have strong emotions while you wait, especially after a first mammogram that was not normal. ACS also says most breast changes are not cancer.

Things that may help:

• Ask when the next test is, when the result comes, and who will call you.
• Ask that earlier images be sent to the center. ACS says callbacks are more common when there is nothing earlier to compare.
• Talk with a loved one, a counselor, or other people who were called back. ACS says this might help.
• Call the ACS helpline at 1-800-227-2345, any time of day or night.

It does not mean screening failed you. It does not mean you should stop on your own. USPSTF recommends a screening mammogram every 2 years for women aged 40 to 74. That advice does not cover people at very high risk, such as those with a BRCA variant. USPSTF says screening every 2 years has a more favorable balance of benefits and harms than screening every year. A clinician who knows your history can help you choose an interval and a test.

• USPSTF — Breast Cancer: Screening (final recommendation, 2024)
• Cumulative Probability of False-Positive Results After 10 Years of Screening With DBT vs Digital Mammography (JAMA Network Open, 2022)
• Pinsky et al., Performance of Lung-RADS in the National Lung Screening Trial (Annals of Internal Medicine, 2015)
• National Cancer Institute — Breast Cancer Screening (PDQ)
• National Cancer Institute — Cancer Screening Overview (PDQ)
• American Cancer Society — Getting Called Back After a Mammogram