Estimating the lifetime risk of a false positive screening test result

Abstract

False positive results in screening tests have potentially severe psychological, medical, and financial consequences for the recipient. To quantify the long-term risk of this phenomenon, we estimate the probability that an individual in one of 14 demographic subpopulations will receive at least one false positive for one of five types of cancer or six STDs in a lifetime, assuming that they adhere to the screening guidelines of the U.S. Preventive Services Task Force. The data collected summarize the results of 116 different medical studies. We specify a suitable model to account for the hierarchical structure of the data, and we rely on the parametric bootstrap to quantify the uncertainty surrounding our estimates. The estimated probability of receiving at least one false positive in a lifetime is 85.5% (±0.9%) and 38.9% (±3.6%) for baseline groups of women and men, respectively, and it is higher for subpopulations recommended to screen more frequently than the baseline. Based on these findings, we encourage healthcare providers to educate patients about lifetime false positive risk, and we introduce an R Shiny dashboard to assist in this endeavor.