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

1996 ◽  
Vol 3 (2) ◽  
pp. 82-84 ◽  
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.

scholarly journals Results from the NHS Breast Screening Programme 1990–1993

1995 ◽  
Vol 2 (4) ◽  
pp. 186-190 ◽  
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.

scholarly journals 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

1997 ◽  
Vol 4 (2) ◽  
pp. 98-101 ◽  
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.

Breast MRI screening of women at average risk of breast cancer: An observational cohort study.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 1-1 ◽  
Author(s):  
Christiane K. Kuhl ◽  
Heribert Bieling ◽  
Kevin Strobel ◽  
Claudia Leutner ◽  
Hans H Schild ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Detection ◽  
Detection Rate ◽  
False Positive Rate ◽  
Interval Cancer ◽  
Breast Mri ◽  
Cancer Detection Rate ◽  
Average Risk ◽  
Cancer Rate ◽  
Interval Cancer Rate

1 Background: Breast-MRI is currently recommended for screening women at high-risk of breast-cancer only. However, despite decades of mammographic-screening, breast-cancer continues to represent a major cause of cancer-death also for women at average-risk – suggesting a need for improved methods for early diagnosis also for these women. Therefore, we investigated the utility of supplemental MRI-screening of women who carry an average-risk of breast-cancer. Methods: Prospective observational cohort-study conducted in two academic breast-centers on asymptomatic women at average-risk in the usual age range for screening-mammography (40 to 70). Women underwent DCE-breast-MRI in addition to mammography every 12, 24, or 36 months, plus follow-up of 2 years to establish a standard-of-reference. We report on the supplemental-cancer-yield, interval-cancer-rate, diagnostic accuracy of screening-MRI, and biologic profiles of additional, MRI-detected breast-cancers. Results: 2120 women underwent a total 3861 MRI-studies covering 7007 women-years. Breast-cancer was diagnosed in 61/2120 women (DCIS: 20, invasive: 41), and ADH/LIN in another 21. Interval-cancer-rate was 0%, irrespective of screening interval. Forty-eight women were diagnosed with breast-cancer at prevalence-screening by MRI alone (supplemental cancer-detection-rate: 22.6 per 1000); 13 women were diagnosed with breast-cancer in 1741 incidence-screening-rounds collected over 4887 women-years. A total 12 of these 13 incident cancers were diagnosed by screening-MRI alone (supplemental-cancer-detection-rate: 6.9 per 1000), one by MRI and mammography, none by mammography alone. Supplemental-cancer-detection-rate was independent of mammographic breast-density. Invasive cancers were small (mean size: 8mm), node-negative in 93.4%, ER/PR-negative in 32.8%, and de-differentiated in 41.7% at prevalence, and 46.0% at incidence-screening. Specificity of MRI-screening was 97.1%, False-Positive-Rate 2.9%. Conclusions: MRI-screening improves detection of biologically relevant breast-cancer in women at average-risk, and reduces the interval-cancer-rate down to 0%, at a low false-positive rate.

Diagnostic performances of supplemental breast ultrasound screening in women with personal history of breast cancer

2017 ◽  
Vol 59 (5) ◽  
pp. 533-539 ◽  
Author(s):  
Sung Eun Song ◽  
Nariya Cho ◽  
Jung Min Chang ◽  
A Jung Chu ◽  
Ann Yi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Detection ◽  
Detection Rate ◽  
Interval Cancer ◽  
Cancer Detection Rate ◽  
Personal History ◽  
Ultrasound Screening ◽  
Cancer Rate ◽  
Interval Cancer Rate ◽  
History Of

Background Supplemental breast ultrasonography (US) has been used as a surveillance imaging method in women with personal history of breast cancer (PHBC). However, there have been limited data regarding diagnostic performances. Purpose To evaluate diagnostic performances of supplemental breast US screening for women with PHBC and to compare with those for women without PHBC. Material and Methods Between 2011 and 2012, 12,230 supplemental US exams were performed in 12,230 women with negative mammograms: 6584 women with PHBC and 5646 women without PHBC. Cancer detection rate, interval cancer rate, abnormal interpretation rate, positive predictive values (PPVs), sensitivity, and specificity were calculated and compared. Results Overall cancer detection rate and first-year interval cancer rate were 1.80/1000 exams and 0.91/1000 negative exams, both of which were higher in women with PHBC than in women without PHBC (2.88 vs. 0.53 per 1000, P = 0.003; 1.50 vs. 0.20 per 1000, P = 0.027). Abnormal interpretation rate was lower in the women with PHBC than in women without PHBC (9.1% vs. 12.1%, P < 0.001). Sensitivity was not different (67.9% vs. 75.0%, P = 1.000), whereas specificity and PPV3 were higher in women with PHBC than in women without PHBC (91.2% vs. 88.0%, P < 0.001; 22.6% vs. 3.1%, P < 0.001). The majority of detected cancers in women with PHBC (78.9%, 15/19) were stage 0 or 1. Conclusion Supplemental breast US screening increases early stage second breast cancers with high specificity and PPV3 in women with PHBC, however, high interval cancer rate in younger women with PHBC should be noted.

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

1998 ◽  
Vol 5 (3) ◽  
pp. 146-155 ◽  
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.

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

2002 ◽  
Vol 9 (2) ◽  
pp. 83-85 ◽  
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.

Breast Cancer Detection Rate: Designing Imaging Trials to Demonstrate Improvements

Radiology ◽  
2007 ◽  
Vol 243 (2) ◽  
pp. 360-367 ◽  
Author(s):  
Yulei Jiang ◽  
Diana L. Miglioretti ◽  
Charles E. Metz ◽  
Robert A. Schmidt
Keyword(s):  
Breast Cancer ◽  
Cancer Detection ◽  
Detection Rate ◽  
Cancer Detection Rate ◽  
Breast Cancer Detection

Validity of process indicators of screening for breast cancer to predict mortality reduction

2005 ◽  
Vol 12 (1) ◽  
pp. 33-37 ◽  
Author(s):  
T Sarkeala ◽  
A Anttila ◽  
I Saarenmaa ◽  
M Hakama
Keyword(s):  
Breast Cancer ◽  
European Community ◽  
Cancer Detection ◽  
Detection Rate ◽  
Randomized Trials ◽  
Recall Rate ◽  
Cancer Detection Rate ◽  
Process Indicators ◽  
The Mean ◽  
Mean Compliance

The aim of the study was to empirically assess the acceptable levels of process indicators as described in the European Community Guidelines using materials from the mammography service screening programmes. The Finnish programme was evaluated for effectiveness with a prior estimateof 0.74 for RR in Finland and 0.81 in Helsinki. Hence, the Finnish programme was likely to be somewhat less effective in terms of reduction in mortality than implied on the basis of early randomized trials, but probably approaching the same level of effectiveness. Finland therefore providesbackground data on the applicability of the process indicators that are indicators of performance and surrogates for effectiveness. The performance data on 10 Finnish screening centres at subsequent screens were used. These centres invited 687,000 women aged 50–64 years in 1991–2000.The mean compliance was 93% and the corresponding recall rate was 2.3%. The benign to malignant biopsy ratio was 0.43:1. The average breast cancer detection rate was 0.36%, 2.1 compared with the background incidence. The proportion of screen-detected stage II+ cancers was 26%. Most, but notall, of these process indicators met the desirable reference values of the European Community. The specific criteria of the European Community on stage distribution, rates of screen-detected cancers by stage and detection rate to background incidence may need reconsideration.

Digital mammography in a screening programme and its implications for pathology: a comparative study

2010 ◽  
Vol 64 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Linda Feeley ◽  
Donal Kiernan ◽  
Therese Mooney ◽  
Fidelma Flanagan ◽  
Gormlaith Hargaden ◽  
...  
Keyword(s):  
Cancer Detection ◽  
Digital Mammography ◽  
Detection Rate ◽  
Screening Programme ◽  
Ductal Carcinoma ◽  
Recall Rate ◽  
Primary Objective ◽  
Cancer Detection Rate ◽  
Detection Rates ◽  
Predictive Values

AimsMost studies comparing full-field digital mammography (FFDM) with conventional screen-film mammography (SFM) have been radiology-based. The pathological implications of FFDM have received little attention in the literature, especially in the context of screening programmes. The primary objective of this retrospective study is to compare FFDM with SFM in a population-based screening programme with regard to a number of pathological parameters.MethodsDuring the study period, 107 818 women underwent screening mammograms with almost equal numbers obtained with each technique (49.9% with SFM vs 50.1% with FFDM). We compared SFM with FFDM using the following parameters: recall rate, diagnostic core biopsy rate, cancer detection rates, B3 rate, B4 rate, preoperative diagnostic rate for malignancy, positive predictive values and tumour characteristics.ResultsThe recall rate was significantly higher with FFDM (4.21% vs 3.52%, p<0.0001). The overall cancer detection rate of 7.2 per 1000 women screened with FFDM was also significantly higher than the rate of 6.2 per 1000 women screened with SFM (p=0.04). The B3 rate in the SFM group was 1.3 per 1000 women screened versus 2.5 per 1000 women screened in the FFDM group (p<0.001). The recall rate and cancer detection rates (overall, invasive and pure ductal carcinoma in situ) were all significantly higher with FFDM for lesions presenting as microcalcifications.ConclusionsThe higher cancer detection rate with FFDM in this study was due to improved detection of microcalcifications. However, this was achieved at the cost of a higher recall rate and a higher B3 rate, indicating that overtreatment may be problematic with digital mammography.

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