Crude open biopsy rates for benign screen detected lesions no longer reflect breast screening quality—time to change the standard

OBJECTIVES: To investigate the changing nature of the benign screen detected breast abnormalities removed at open biopsy over a seven year period and to compare this with the improving cancer detection rate and non-operative diagnosis rate. SETTING: The Bolton, Bury, and Rochdale Breast Screening Programme. METHODS: The histopathology reports of the benign lesions removed from patients undergoing open biopsy for screen detected abnormalities between 1 April 1994 and 31 March 2001 were reviewed and the lesions classified on the B1 to B5 scale. Cancer detection rates and non-operative cancer diagnosis rates were ascertained from the breast screening computer system. RESULTS: 148 benign surgical biopsies were performed in the seven year period. There was a moderate increase in the overall benign biopsy rate over the period (from 1.26 open biopsies per 1000 women screened for the three years 1994–97 to 1.63 open biopsies per 1000 women screened for the three years 1998–2001). The biopsy rate for B2 (benign) lesions decreased slightly over the study period but the biopsy rate for B3 lesions (that is, of uncertain malignant potential) more than doubled. The majority (84%) of the B3 lesions were radial scars. There was a steady improvement in the cancer detection rate and the non-operative cancer diagnosis rate over the period, similar to that seen nationally. CONCLUSIONS: Improvements in screening technique and detection ability result in an increase in the number of subtle radiologically indeterminate or suspicious lesions detected. Many of these are radial scars, which require excision. Crude benign open biopsy rates for screening programmes are no longer meaningful, and should now be refined with separate rates for B2 lesions and B3 lesions. High quality programmes can expect to have low B2 open biopsy rates and high B3 open biopsy rates. It is inappropriate to have an upper limit for the B3 open biopsy rate.

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Use of Two View Mammography Compared with One View in the Detection of Small Invasive Cancers: Further Results from the National Health Service Breast Screening Programme

Journal of Medical Screening ◽

10.1177/096914139700400206 ◽

1997 ◽

Vol 4 (2) ◽

pp. 98-101 ◽

Cited By ~ 24

Author(s):

R G Blanks ◽

S M Moss ◽

M G Wallis

Keyword(s):

National Health Service ◽

Health Service ◽

Cancer Detection ◽

Breast Screening ◽

Detection Rate ◽

Screening Programme ◽

Cancer Detection Rate ◽

Invasive Cancer ◽

Breast Screening Programme ◽

National Health Service Breast

Objective— To examine further the effect of using two view mammography in comparison with one view mammography in the detection of small (<15 mm) invasive cancers for programmes in the National Health Service breast screening programme (NHSBSP). The study is in two parts: First the effect on the small invasive cancer detection rate for programmes that changed from using one view to two views for first (prevalent) screens, and secondly the effect on the small invasive cancer detection rate for programmes that used two views for subsequent (incident) screens compared with programmes that used one view. Setting— Screening programme data from the NHSBSP. Methods— Data were collated from all screening programmes in the United Kingdom on standard “Korner” returns (KC62 forms) for the screening years 1 April 1994 to 31 March 1995 and 1 April 199S to 31 March 1996. The comparison between one and two view mammography was made using indirectly age standardised invasive cancer detection rates. Results— For prevalent (first) screens, programmes changing from one view mammography in 1994/95 to two views in 1995/96 reported a 45% (95% confidence interval (CI) 25% to 68%) increase in the detection of invasive cancers of <15 mm. In comparison, programmes that were already using two views in 1994/95 showed no change in 1995/96. For incident (subsequent) screens the small number of programmes that have opted to use two views reported 25% (95% CI 1% to 55%) more invasive cancers of <15 mm than programmes using one view in 1995/96, and 42% (95% CI 11% to 81%) more in 1994/95. Conclusions— These results confirm the benefit of using two view mammography in the detection of small invasive cancers, and provide evidence that this effect is seen in subsequent screens as well as the first screen.

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Results from the NHS Breast Screening Programme 1990–1993

Journal of Medical Screening ◽

10.1177/096914139500200403 ◽

1995 ◽

Vol 2 (4) ◽

pp. 186-190 ◽

Cited By ~ 34

Author(s):

S M Moss ◽

M Michel ◽

J Patnick ◽

L Johns ◽

R Blanks ◽

...

Keyword(s):

Cancer Detection ◽

Breast Screening ◽

Detection Rate ◽

Screening Programme ◽

Interval Cancer ◽

Cancer Detection Rate ◽

Quality Assurance Programme ◽

Detection Rates ◽

Breast Screening Programme ◽

Single View

Objective –To present results from the NHS breast screening programme (NHSBSP) for the three year period 1990 to 1993, and to examine the extent to which interim targets are being met. Methods –Data have been collated from all screening programmes in the United Kingdom on standard “Korner” returns, supplemented for the year 1991/92 by data from the radiology quality assurance programme. Most of the data refer to the prevalent screening round, but some data on rescreening are also available. Results –The total cancer detection rate at prevalent screens was 6·0/1000, 18% being in situ cancers; the detection rate of invasive cancers ⩽ 10 mm in diameter was 1·3/1000, but data on size were missing for 12% of cancers. Referral rates were significantly lower for programmes using' two view mammography at the prevalent screen than for those using single view, and cancer detection rates were significantly higher. For prevalent screens over the three year period, 70% of programmes had a referral rate of ≤ 7%, 87% had a benign biopsy rate of ≤ 5/1000, and 79% had a cancer detection rate of ≥ 5/1000. By contrast, only 30% of programmes appeared to meet the target detection rate of > ⩽5/1000 for invasive cancers ≤ 10 mm in diameter. Conclusions – While the majority of interim targets are being met by the NHSBSP, the rate of detection of small invasive cancers requires careful monitoring. Collection of more accurate data on size of cancers and interval cancer rates will give a better indication of progress towards the target mortality reduction.

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Consensus Review of Discordant Findings Maximizes Cancer Detection Rate in Double-Reader Screening Mammography: Irish National Breast Screening Program Experience

Radiology ◽

10.1148/radiol.2502080224 ◽

2009 ◽

Vol 250 (2) ◽

pp. 354-362 ◽

Cited By ~ 32

Author(s):

Colette M. Shaw ◽

Fidema L. Flanagan ◽

Helen M. Fenlon ◽

Michelle M. McNicholas

Keyword(s):

Cancer Detection ◽

Breast Screening ◽

Detection Rate ◽

Screening Program ◽

Screening Mammography ◽

Cancer Detection Rate ◽

National Breast

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The Added Value of Supplemental Breast Ultrasound Screening for Women With Dense Breasts: A Single Center Canadian Experience

Canadian Association of Radiologists Journal ◽

10.1177/08465371211011707 ◽

2021 ◽

pp. 084653712110117

Author(s):

Tong Wu ◽

Linda J. Warren

Keyword(s):

Breast Cancer ◽

Cancer Detection ◽

Detection Rate ◽

Breast Ultrasound ◽

Cancer Detection Rate ◽

Ultrasound Screening ◽

Dense Breasts ◽

Screening Ultrasound ◽

Average Tumor Size ◽

Biopsy Rate

Purpose: We evaluated the contribution to cancer detection of supplemental breast ultrasound screening in women with dense breasts based on a single center experience by comparing our results with similar programs elsewhere. Methods: We performed a retrospective review of handheld sonographer-performed screening ultrasound exams at our academic breast imaging center, from January 1st to December 31st, 2019. Breast density, breast cancer risk factors, BI-RADS assessment, and lesion pathology were reviewed and tallied, followed by derivation of the biopsy rate, breast cancer detection rate, PPV3 and average tumor size. These values were compared to published results of breast screening programs elsewhere. Results: 695 screening breast ultrasounds for women with dense breasts and negative mammograms were performed in 2019. The biopsy rate was 1.3%, breast cancer detection rate was 7 in 1000, PPV3 was 42%, and the average tumor size was 9.0 ± 1.4 mm. Conclusions: The first-year data of the breast screening ultrasound program at our practice are promising, demonstrating comparable cancer detection rate, higher PPV3, and similar biopsy rate in those with dense breasts compared with similar programs elsewhere. Longitudinal analysis and larger sample size are required for validation. Comparison of incidence and prevalence screening data is also warranted to elucidate the true value of this program.

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Monitoring the Performance of Breast Screening Programmes: Allowing for Geographical Variation in Breast Cancer Incidence

Journal of Medical Screening ◽

10.1177/096914139600300207 ◽

1996 ◽

Vol 3 (2) ◽

pp. 82-84 ◽

Cited By ~ 12

Author(s):

RG Blanks ◽

SM Moss

Keyword(s):

Breast Cancer ◽

Cancer Detection ◽

Cancer Incidence ◽

Breast Screening ◽

Detection Rate ◽

Screening Programme ◽

Breast Cancer Incidence ◽

Interval Cancer ◽

Cancer Detection Rate ◽

Catchment Areas

Among the myriad of problems associated with evaluating the performance of individual screening programmes in the National Health Service breast screening programme is that of correcting for background breast cancer incidence in the catchment areas of individual programmes. The background incidence will affect not only the expected cancer detection rate at screening, but also the interval cancer rates. This paper proposes a method that can be used to correct for background incidence. The method can be used either to correct the crude cancer detection rate or the age adjusted cancer detection rate using a measure such as the standardised detection ratio. Variation in background incidence and age distribution of screened women are the two major factors affecting the expected cancer detection rate for individual screening programmes. Control of these two variables should allow more effective evaluation of individual screening programme performance.

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Early rescreen/recall in the UK National Health Service breast screening programme: epidemiological data

Journal of Medical Screening ◽

10.1136/jms.5.3.146 ◽

1998 ◽

Vol 5 (3) ◽

pp. 146-155 ◽

Cited By ~ 15

Author(s):

G J Ong ◽

J Austoker ◽

M Michell

Keyword(s):

National Health Service ◽

Cancer Detection ◽

Breast Screening ◽

Detection Rate ◽

Screening Programme ◽

Epidemiological Data ◽

Cancer Detection Rate ◽

Breast Screening Programme ◽

The United Kingdom ◽

National Health Service Breast

Objective In the United Kingdom in 1994–95 about 16 500 women aged 50 to 64 were asked to come back earlier than the usual three yearly screening interval for further mammography (early rescreen (ES)) or for a range of further investigations at an assessment centre (early recall (ER)). This study aimed at providing epidemiological data on ES/ER, in particular, how often and why it is used, and what the outcome is of using it. Setting National Health Service breast screening programme in the United Kingdom. Methods All breast screening units were invited to complete a postal questionnaire. Two reminders were sent. The units were asked retrospectively to provide breast screening data about women aged 50 to 64 from their local computer systems. Women placed on ES/ER were followed up for at least one year. Results The response rate was 71% (69/97), of which 14% (10/69) were unable to provide the required data, leaving 59 completed questionnaires (61%). The rate of placing women on ES/ER was above 1.0% for 26/54 (48%) responding breast screening units and above 2.0% for 13/54 (24%) units. Women were placed on ES/ER because of ( a) previous breast cancer (21% of cases; cancer detection rate 2.4%), ( b) diagnostic uncertainty (51%; cancer detection rate 3.0%), or ( c) family history (27%; cancer detection rate 0.6%). Breast screening units with a high rate of placing women on ER were significantly more likely to have a high recall rate ( rS=0.63; n=53; p<0.0005) or a high benign surgical biopsy rate ( rS=0.33; n=49; p<0.05), or both. The cancer detection rate of ES/ER tended to decrease with increasing ES/ER rates ( rS=−0.37; n=51; p<0.01). Conclusions A relatively large number of women were placed on ES or ER for a range of reasons. If the recommendations given are followed, the number of women placed on ER may be reduced while maintaining the cancer detection rate at the required level. The option of ES should not be used.

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