Association between Screening Mammography Recall Rate and Interval Cancers in the UK Breast Cancer Service Screening Program: A Cohort Study

Abstract

Purpose To determine whether low levels of recall lead to increased interval cancers and the magnitude of this effect. Materials and Methods The authors retrospectively analyzed prospectively collected data from the UK National Health Service Breast Screening Programme during a 36-month period (April 1, 2005 to March 31, 2008), with 3-year follow-up in women aged 50-70 years. Data on recall, cancers detected at screening, and interval cancers were available for each of the 84 breast screening units and for each year (n = 252). The association between interval cancers and recalls was modeled by using Poisson regression on aggregated data and according to age (5-year intervals) and screening type (prevalent vs incident). Results The authors analyzed 5 126 689 screening episodes, demonstrating an average recall to assessment rate (RAR) of 4.56% (range, 1.64%-8.42%; standard deviation, 1.15%), cancer detection rate of 8.1 per 1000 women screened, and interval cancer rate (ICR) of 3.1 per 1000 women screened. Overall, a significant negative association was found between RAR and ICR (Poisson regression coefficient: -0.039 [95% confidence interval: -0.062, -0.017]; P = .001), with approximately one fewer interval cancer for every additional 80-84 recalls. Subgroup analysis revealed similar negative correlations in women aged 50-54 years (P = .002), 60-64 years (P = .01), and 65-69 years (P = .008) as well as in incident screens (P = .001) and prevalent screens (P = .04). No significant relationship was found in women aged 55-59 years (P = .46). Conclusion There was a statistically significant negative correlation between RAR and ICR, which suggests the merit of a minimum threshold for RAR. RSNA, 2018 Online supplemental material is available for this article.

True and Missed Interval Cancer in Organized Mammographic Screening: A Retrospective Review Study of Diagnostic and Prior Screening Mammograms

“…Double-reading of mammograms is demonstrated to reduce the interval cancer rates compared with single-reading (179). In addition, the expected or accepted recall rate in the program may influence the incidence of interval cancer; by accepting a higher rate of recall, a higher number of subtle findingswhich otherwise may develop and be diagnosed as interval cancer -might be recalled for further assessment compared with a program in which very low recall rates are anticipated (180,181). However, a modelling study demonstrated that an increase in recall rate above approximately 7% resulted in only a slight increase in detection of low grade non-invasive cancers and no further increased detection of invasive and high grade non-invasive cancers (182).…”

Comparison of the utility of clinical breast examination and MRI in the surveillance of women with a high risk of breast cancer

“…9,16 A study in St James's Hospital, by Healy et al, 25 between 2009 to 2014, documented a 5-year recall rate of 10.9%, suggesting a relatively static recall rate. A recall rate of 23.6%, was documented for MRI surveillance, in Boston, USA, by Lehman et al 26 Although studies do not exist in the area of screening breast MRI, a recent study by Burnside and colleagues 27 demonstrated that lower screening mammography recall rates correlated with higher interval cancer rates. Based on their findings, they suggest that a minimum recall rate may be of value to enable the benefit of preclinical breast cancer diagnoses.…”

Subsequent attendance in a breast cancer screening program after a false-positive result in the Local Health Authority of Bologna (Italy)

“…As highlighted in other similar studies, our data are aggregated and anonymized; thus, we do not have access to detailed demographic risk factors beyond age. As a result, we cannot perform subgroup analyses on variables that are known to affect attendance 45 . Finally, we have not considered/excluded women who have developed cancer in the call range after the FPR.…”