Strategies for improvement of population based breast cancer screening
Elisabeth G. Klompenhouwer · 2015
ObjectivesTo determine the re-attendance rate at screening mammography after a single or a repeated false positive recall and to assess the effects of transition from screen-film mammography (SFM) to full-field digital mammography (FFDM) on screening outcome in women recalled twice for the same mammographic abnormality. MethodsThe study population consisted of a consecutive series of 302,912 SFM and 90,288 FFDM screens.During a two years follow-up period (until the next biennial screen) we collected the breast imaging reports and biopsy results of all recalled women. ResultsRe-attendance at biennial screening mammography was 93.2% (95%CI-93.1%-93.3%)for women with a negative screen (i.e., no recall at screening mammography), 65.4% (95%CI 64.0%-66.8%)for women recalled once, 56.7% (95%CI 47.1%-66.4%)for women recalled twice but for different lesions and 44.3% (95%CI 31.4%-57.1%)for women recalled twice for the same lesion.FFDM recalls comprised a significantly larger proportion of women who had been recalled twice for the same lesion (1.9% of recalls (52 women) at FFDM versus 0.9% of recalls (37 women) at SFM, P<0.001) and the positive predictive value of these recalls (PPV) was significantly lower at FFDM (15.4% versus 35.1%, P=0.03).At review, 20 of 52 women (39.5%, all with benign outcome) would not have been recalled for a second time at FFDM if the previous hard copy SFM screen had been available for comparison. ConclusionA repeated false positive recall for the same lesion significantly lowered the probability of screening re-attendance.The first round of FFDM significantly increased the proportion of women recalled twice for the same lesion, with a significantly lower PPV of these lesions.Almost 40% of repeatedly recalled women would not have been recalled the second time if the previous hard copy SFM screen had been available for comparison at the time of FFDM.