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False-positive mammogram results discourage women from future screenings

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A new study has has found that women who received a false-positive result that required additional imaging or biopsy were less likely to return for that follow-up screening.

Early detection of breast cancer through mammography screening continues to save lives. However, abnormal findings on mammograms can lead to women being recalled for additional imaging and biopsies, many of which turn out to be “false positives,” meaning they do not result in a cancer diagnosis.

False positives can also have financial implications for patients and cause significant emotional anxiety.

The new study analysed data on more than 3.5 million screening mammograms nationwide performed between 2005-2017 on over 1 million patients aged 40 to 73.

“The finding raises concerns about the potential unintended consequence of false-positive results, where women may avoid screening mammograms in the future,” said lead author Diana Miglioretti, cancer center researcher and chief of the Division of Biostatistics at UC Davis.

Findings are worrisome to researchers

The study found that 77 per cent of women with a negative result from a mammogram returned for subsequent screening. But this percentage dropped to 61 per cent after a false-positive finding requiring another mammogram in six months to confirm the results and 67 per cent if a biopsy was recommended.

The impact was even more pronounced for women who received false-positive results on two consecutive mammograms recommending short-interval follow-up—only 56 per cent returned their next screening mammogram.

The high rate of women who don’t return for future screening is concerning to the research team.

“It is important for women with false-positive results to continue screening every one to two years,” Miglioretti said.

“Having a false-positive result, especially if it results in a diagnosis of benign breast disease, is associated with an increased risk of being diagnosed with breast cancer in the future.”

The research also showed that Asian and Hispanic/Latinx women were the least likely to return for future screening mammograms after a false positive result, which may contribute to existing health disparities.

False-positive results are common, especially among younger women. They occur in 10 to 12 per cent of mammograms in women 40 to 49 years of age. After 10 years of annual screenings, 50 to 60 per cent of women can expect at least one false-positive and 7 to 12 per cent at least one false-positive with a biopsy recommendation.

“It’s important to understand that most women recalled for additional imaging due to a finding on a screening mammogram do not have breast cancer,” Miglioretti said.

“They should try not to be worried if they are recalled for additional work-up. it is a normal and common part of the screening process.”

It is important for women to understand that about 10 per cent of the time, additional imaging is necessary to get a better look at a finding on a screening mammogram.

Steps to consider

Miglioretti said women who feel anxious while waiting for their screening mammography results might consider requesting an on-the-spot interpretation of their mammogram. Some facilities provide this service along with same-day diagnostic work-up, if there is a suspicious finding.

She said it is also important for physicians to carefully explain false-positive results to their patients to reassure them that the result was negative and stress the importance of continued screening.

The study was led by the UC Davis Comprehensive Cancer Center and published in the Annals of Internal Medicine.

Diagnosis

Targeted nanotherapy shows endometriosis promise

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A targeted nanotherapy reduced endometriosis lesions and pain sensitivity after a single dose in mice, early research has found.

The experimental treatment uses a nanoparticle to deliver an existing drug to immune cells associated with endometriosis.

Researchers hope the approach could eventually lead to a treatment for people with the chronic condition, but it has not yet been tested in humans.

Kanako Hayashi, professor in Washington State University’s School of Molecular Biosciences in the College of Veterinary Medicine and a corresponding author of the research, said: “We found the disease-specific immune cell, and then we had a drug, but we couldn’t target the cell with the drug alone.

“So we used this nanocarrier that delivers the drug specifically to the disease site.”

The Washington State University team developed the therapy after previously identifying a distinct population of macrophages associated with endometriosis. Macrophages are white blood cells involved in immune defence.

They designed a nanocarrier, a specialised molecule used to transport drugs to the disease site, to target these cells without affecting surrounding cells and tissue.

The treatment uses niclosamide, a drug approved to treat intestinal tapeworms that is also being studied for other potential uses, including cancer treatment.

Previous research by the team found that niclosamide could reduce endometriosis lesions. However, the drug has low solubility, meaning large amounts are needed for it to work and limiting how long it can safely be taken.

The researchers engineered a nano-sized molecule called a dendrimer to bond with niclosamide and deliver it in a more soluble form.

In a mouse model, a single injection reduced the size and number of endometriosis lesions as well as sensitivity to pain.

Endometriosis affects roughly 190 million women worldwide and occurs when lesions similar to tissue inside the uterus grow outside it.

Symptoms can include chronic pain, severe cramps, pain during sex and infertility. Hormonal therapies can help manage symptoms but may affect fertility and bone density, while surgery can remove lesions but its effectiveness may be short-term.

Recent research has focused on immune system dysfunction in endometriosis, particularly problems involving macrophages.

The researchers are working with the WSU Office of Entrepreneurship and Innovation as they pursue patenting and commercialisation opportunities and seek support to test the technology in human trials.

Hayashi said: “Although we still need to clear multiple phases, this study is telling us the efficacy is strong, and this nanocarrier is stable, so far, for two weeks—and we think we can go longer.

“The idea is that if it’s stable for a month, you could go to the doctor once a month, get the shot, either IV or muscle injection, and then go home.”

 

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Insight

Charity launches Women’s Health Plan to tackle inequalities in long-term conditions

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 Chest Heart & Stroke Scotland has launched a three-year Women’s Health Plan setting out actions to improve prevention, diagnosis, treatment and support for women in Scotland.

The 2026 to 2029 plan includes commitments on health information, prevention and early detection, professional training, peer support, post-diagnosis care, policy and research.

It comes amid disparities affecting women with chest, heart and stroke conditions, including differences in diagnosis, testing and treatment.

Figures cited by the charity show women in Scotland are 50 per cent more likely than men to receive an initial misdiagnosis after a heart attack.

Jane-Claire Judson, chief executive of Chest Heart & Stroke Scotland, said: “Women have been telling us for years that their symptoms aren’t being taken seriously, and the evidence backs them up.

“When we talk about women’s health, we need to look beyond reproductive and maternal health alone.

“Women experience inequalities across a wide range of conditions, including chest, heart, stroke and Long Covid conditions, and they deserve equitable access to the information, support and care they need.

“Our CHSS Women’s Health Plan is about listening to those experiences and turning them into meaningful action.”

Across the UK, women are twice as likely to be misdiagnosed with heart failure, with many waiting an average of 20 weeks for a diagnosis, compared with 3.6 weeks for men.

There are more than 4,600 incidences of stroke in women in Scotland each year, with more than 1,200 dying as a result.

Asthma and chronic obstructive pulmonary disease (COPD) are also more common among women, while women are nearly twice as likely as men to die from asthma.

Women are less likely to be offered diagnostic testing within 72 hours of a heart attack and less likely to be prescribed medication that reduces the risk of a second heart attack, according to the charity.

CHSS also said conditions that predominantly affect women, including Long Covid and heart conditions such as coronary microvascular dysfunction, remain under-researched and under-diagnosed.

Four in five women say they are not listened to by healthcare professionals, while UK female life expectancy has fallen from 20th to 26th place among 38 OECD countries in recent years.

The Women’s Health Plan includes developing women-specific health information and launching a prevention and early detection programme through CHSS’s Health Defence and Community Healthcare Support Service.

Other commitments include raising the visibility of women’s health, strengthening training for healthcare professionals, CHSS colleagues and volunteers, expanding peer support and post-diagnosis care, and campaigning for changes to policy, funding and women’s inclusion in research.

The charity also plans to drive continuous improvement in its women’s health work, shaped by lived experience.

CHSS said it will seek to address inequalities through prevention programmes, professional education, policy influence and improved support for women across Scotland.

The plan builds on CHSS’s women’s health work launched in 2021 and its wider No Life Half Lived strategy. It also aligns with phases one and two of the Scottish Government’s Women’s Health Plan.

More than 140 responses to a national survey helped shape the plan, alongside consultation with health and social care professionals and people with lived experience through CHSS’s Voices of Experience Panel.

Judson said: “By improving awareness, supporting earlier detection and diagnosis, and ensuring women are heard when they seek help, we can begin to address inequalities that have persisted for far too long.

“Our first plan, launched in 2021, established important foundations.

“This next phase builds on that progress and reflects our commitment to a Scotland, where nobody is left behind because of their sex or gender.

“At Chest Heart & Stroke Scotland, our No Life Half Lived mission means working towards a future where everyone can live well with their condition. By bringing together women with lived experience, health professionals, policymakers and partners, we can create lasting change and help build a fairer, healthier Scotland for women.”

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Features

Gender gap in treatment persists even when men and women have same condition

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Women with the same medical conditions as men were less likely to receive the same treatment across several specialties, a global research review found.

The review found differences in care for conditions including cardiovascular disease, kidney disease and Parkinson’s, with women less likely to receive some active treatments.

Of 38 studies analysed, 33 found women were less likely than men to be offered active treatment.

Researchers at the University of St Andrews found women with myocardial infarction, heart failure or an irregular heartbeat were more likely to receive medication, while men were more likely to undergo coronary bypass surgery, stenting or other surgical treatment.

Women were also less likely to be prescribed statins.

Men with Parkinson’s were more likely to be referred for deep brain stimulation.

Men with liver failure were more likely to receive a transplant, while women with kidney disease requiring dialysis were less likely to receive permanent access and spent longer using a catheter.

Women were also less likely to receive opioids for pain management.

The researchers found no significant difference between women and men in treatment for stroke or diabetes, while women were more likely to receive treatment for dementia.

None of the studies identified clinical guidelines recommending different treatment based on sex.

Researchers said this suggested the differences could not be explained by the need for different clinical approaches to women’s health.

Dr Andrew O’Malley, who co-led the study, said: “For clinicians, the findings are a prompt to check whether treatment is being offered on clinical grounds rather than assumption.”

He said studies showed doctors more often attributed women’s symptoms to anxiety and made more diagnostic errors with female patients, even when test results were positive.

Dr Miriam Veenhuizen, honorary lecturer in the School of Medicine at St Andrews, said: “While the direction of the findings was not a surprise, the consistency was. The same pattern appeared in cardiology, surgery, transplant medicine and emergency care, and it survived statistical adjustment in most studies.”

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