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Keywords:
Breast, Mammography, Diagnostic procedure, Screening, Biopsy, Cancer, Pathology
Authors:
B. Omay1, A. Sever1, J. Weeks2, R. Pietrosanu2, P. Mills3; 1Ankara/TR, 2Maidstone/UK, 3Kent/UK
DOI:
10.1594/ecr2015/C-2104
Conclusion
Whether breast cancer screening does more harm than good has been debated extensively.
The main questions are how large the benefit of screening is in terms of reduced breast cancer mortality and how substantial the harm is in terms of overdiagnosis [3].
The major harms consist of false positive results,
unnecessary additional imaging,
and the need for biopsy and potential biopsy related complications.
However,
in a study carried out by Ganott et al.,
a substantial fraction of women would have preferred the inconvenience of and anxiety associated with a higher recall rate if it resulted in the possibility of detecting breast cancer earlier [4].
In this screening programme,
mammograms showing minimal signs of cancer which were categorized as BI-RADS 4A comprised the largest recall group (70%) with a relatively low cancer detection rate (6,8%),
and high non-malignant biopsy rate (14,1%).
In the study by Otten et al.
(5),
they stated that breast cancer can be detected earlier by lowering the threshold for recall,
especially for recall rates of 1% – 4%.
With further recall rate increases,
cancer detection levels off with a disproportionate increase of false-positive rates.
Similar to that study,
if patient recall was limited to only more suspicious groups (BI-RADS 4B and above) in our screening programme,
overall recall rate would have dropped to 1%,
and 440 benign biopsies (81%) would have been avoided.
However,
28% of the cancers would have been missed,
which may surface as interval cancers or late screen-detected cancers at a more advanced tumour stage.
Patient anxiety generated due to false positive recalls and the cost of assessment clinics need to be carefully balanced against a higher cancer detection rate.