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

14 Background: Founded in 1988, The Screening Mammography Program of British Columbia (SMPBC) is a large, and stable screening program and a formal review of its effectiveness provides suggestions for further improvements. The purpose of this study is to quantify and report trends of the SMPBC and to assess if there have been any major changes in outcomes over the past fifteen years as this program has matured. Methods: A retrospective review of the SMPBC was performed by extracting data from the past 15 years from the SMPBC Annual Reports. The changes and trends in percentage of eligible population screened/participation rate, number of screening exams and number of first screens performed, overall cancer detection rate, and DCIS detection rate was extracted and reported. Furthermore, cost analysis data was extracted, and adjusted to compensate for inflation using The Bank of Canada Inflation Calculator, which bases its calculations from the Canadian Consumer Price Index (CPI) from Statistics Canada. Results: Over the past 15 years, the total number of exams provided per year has almost doubled from 166,746 in 1996 to 303,157 in 2010, and this increase accommodates the overall and aging growth of the BC population. An increasing participation rate is seen from 1999-2009 for women from rural sites and traditionally underserved areas of British Columbia, while the overall participation rate over this time period remains stable (range 48%-51%). The cancer detection rate also remains stable (range: 3.4-4.5 cases per 1000 screens). After adjusting for inflation, a 12.6% increase in the cost per screen from 1995-2009 is observed. This increase is multifactorial and includes an increase in operating costs central services and physician reading fees. Conclusions: The province of British Columbia has consistently had the lowest rates of breast cancer related mortality in Canada, and this may be, in part, because of the long term stability of the BC Screening Mammography Program. Our report suggests that the SMPBC has been effective in accommodating the growing aging population, although there is still room for improvement, as a target participation of 70% is considered the standard to effectively reduce mortality through screening.

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

Journal of Medical Screening ◽

10.1136/jms.9.2.83 ◽

2002 ◽

Vol 9 (2) ◽

pp. 83-85 ◽

Cited By ~ 6

Author(s):

A.J. Maxwell ◽

J.M. Pearson ◽

H.M. Bishop

Keyword(s):

Cancer Detection ◽

Cancer Diagnosis ◽

Breast Screening ◽

Detection Rate ◽

Cancer Detection Rate ◽

Benign Lesions ◽

Open Biopsy ◽

B3 Lesions ◽

Diagnosis Rate ◽

Biopsy Rate

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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Increased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening Program

Radiology ◽

10.1148/radiol.2015142036 ◽

2016 ◽

Vol 278 (3) ◽

pp. 698-706 ◽

Cited By ~ 67

Author(s):

Richard E. Sharpe ◽

Shambavi Venkataraman ◽

Jordana Phillips ◽

Vandana Dialani ◽

Valerie J. Fein-Zachary ◽

...

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

Screening Program ◽

Digital Breast Tomosynthesis ◽

Recall Rate ◽

Population Based ◽

Cancer Detection Rate ◽

Breast Tomosynthesis

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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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Voluntary Screening Program for Prostate Cancer: Detection Rate and Cost

Southern Medical Journal ◽

10.1097/00007611-199408000-00003 ◽

1994 ◽

Vol 87 (8) ◽

pp. 785-788 ◽

Cited By ~ 3

Author(s):

NEIL ABRAMSON ◽

SHIRLEY COTTON ◽

RONALD ECKELS ◽

JAMES BALDOCK

Keyword(s):

Prostate Cancer ◽

Cancer Detection ◽

Detection Rate ◽

Screening Program ◽

Cancer Detection Rate ◽

Prostate Cancer Detection

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The Association of Breast Pain with Malignancy

Journal of Breast Imaging ◽

10.1093/jbi/wbz029 ◽

2019 ◽

Vol 1 (3) ◽

pp. 177-181

Author(s):

Anna I Holbrook ◽

James Zhang ◽

Kelly D’amico ◽

Yuan Liu ◽

Mary S Newell

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

Screening Mammography ◽

Cancer Detection Rate ◽

Breast Pain ◽

Chi Square ◽

Imaging Evaluation ◽

Detection Rates ◽

The Difference ◽

Risk Of Cancer

Abstract Objective Breast pain is a common reason for imaging evaluation; however, the limited literature available suggests a low incidence of malignancy with isolated pain. The goal of this study is to calculate the risk of cancer in patients with breast pain, and to compare to the screening mammography cancer detection rates. Methods This retrospective, institutional review board–approved study included all patients for whom a breast pain history sheet was filled out between November 3, 2013, and July 28, 2016. Those without at least two years of follow-up were excluded. From the medical record, any malignancy found at the site of pain at presentation or within two years was noted. Screening cancer detection rate was calculated from the mammography tracking software, and the Chi-square test was used to evaluate the significance of the difference between the cancer detection rates in patients with pain versus that detected by screening. Results Of 421 patients who met the inclusion criteria, 4 (1.0%) had cancer at the site of pain, with a rate of malignancy of 9.5/1000 (95% CI: 3.5/1000 to 25.2/1000). The screening cancer detection rate was 7.3/1000 (P = 0.403), which was not significantly different. All cancers occurred in patients with coexisting palpable abnormalities; none was found when pain was the only symptom. Conclusion The rate of malignancy in patients with breast pain did not differ significantly from that detected by screening mammography. In patients with isolated breast pain without a palpable abnormality, there were no cases of malignancy. Imaging patients for the sole purpose of evaluating breast pain may not be necessary.

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Increased Cancer Detection Rate and Variations in the Recall Rate Resulting from Implementation of 3D Digital Breast Tomosynthesis into a Population-based Screening Program

Radiology ◽

10.1148/radiol.2016164018 ◽

2016 ◽

Vol 280 (3) ◽

pp. 981-981 ◽

Cited By ~ 5

Author(s):

Richard E. Sharpe ◽

Shambavi Venkataraman ◽

Jordana Phillips ◽

Vandana Dialani ◽

Valerie J. Fein-Zachary ◽

...

Keyword(s):

Cancer Detection ◽

Detection Rate ◽

Screening Program ◽

Digital Breast Tomosynthesis ◽

Recall Rate ◽

Population Based ◽

Cancer Detection Rate ◽

Breast Tomosynthesis

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Tomosynthesis-Guided Core Biopsy of the Breast: Why and How to Use it

Journal of Clinical Imaging Science ◽

10.4103/jcis.jcis_10_18 ◽

2018 ◽

Vol 8 ◽

pp. 28 ◽

Cited By ~ 3

Author(s):

Kyungmin Shin ◽

Davis Teichgraeber ◽

Sarah Martaindale ◽

Gary J Whitman

Keyword(s):

Cancer Detection ◽

Core Biopsy ◽

Breast Imaging ◽

Detection Rate ◽

Clinical Symptoms ◽

Digital Breast Tomosynthesis ◽

Screening Mammography ◽

Cancer Detection Rate ◽

Breast Tomosynthesis

Digital breast tomosynthesis (DBT) has become an important tool in breast imaging. It decreases the call-back rate while increasing the cancer detection rate on screening mammography and is useful for diagnostic examination of noncalcified lesions and for the evaluation of patients presenting with clinical symptoms. Management challenges and dilemmas that are encountered with abnormalities detected on DBT and lacking a sonographic correlate can now be addressed with tomosynthesis-guided core biopsy.

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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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