International comparison of performance measures for screening mammography: can it be done?

Yankaskas, BC; Cn, Klabunde; Ancelle-Park, R.; Rennert, Gad; Wang, H; Fracheboud, Jacques; Pou, Gonzalo; Bulliard, Jean‐Luc

doi:10.1258/0969141042467430

Cited by 83 publications

(80 citation statements)

References 37 publications

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“…21,32 In contrast this research showed lower recall rates in the 51 to 55 years age group. Moreover, results revealed that younger women were more likely to have a negative diagnosis after the initial mammogram, and older women were more likely to be recalled.…”

Section: Discussioncontrasting

confidence: 76%

“…4 Previous research states that recall rates were influenced by several factors including training and experience of radiologists, image quality, the volume of mammograms interpreted and the age of screened women. 19,20,21 Early Recall Rate ER was found to be associated with a low predictive value for malignancy and thus every effort should be made to obtain a definitive diagnosis at initial assessment. 4,22,23,24 Additionally, a study analysing 110 women who were recalled early, revealed that 3.6% had invasive cancer, 0.9% had DCIS, while 84% had benign findings.…”

mentioning

confidence: 99%

“…The training of radiologists is an important factor affecting the recall rate. 21 The researcher had no evidence whether this factor affected the recall rate locally. However, the fact that this was the first experience for local radiologists to work within a screening program might have had an impact on the recall rate as acknowledged in literature.…”

mentioning

confidence: 99%

“…However, the fact that this was the first experience for local radiologists to work within a screening program might have had an impact on the recall rate as acknowledged in literature. 21 Local radiologists might have also recalled women with suspicious findings, even in the absence of a possibility of cancer, to avoid possible malpractice litigation. Additionally, reading an average of 3600 mammograms yearly, local radiologists are considered to be low volume readers compared with the stipulated 5000 yearly mammograms which European guidelines recommend.…”

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confidence: 99%

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A retrospective audit of the first screening round of the Maltese breast screening programme

2017

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Purpose: To analyse whether the screening performance parameters of the Maltese National Breast Screening Programme first screening round met requirements set by European standards. The association between screening age and results of screening performance parameters was also investigated. Method:Quantitative methodology was used to review examinations of women who were recalled for a technical recall or further assessment rates. All accessible members of the population recalled during the first round were retrospectively reviewed resulting in a sample of 2300 recalled examinations.Results: Malta's first screening round met the European Guidelines recommendations for technical repeat rate (0.26%), early recall rate (0.45%), breast cancer detection rate (13.77 per 1000 women) and Positive Predictive Value of screening test (7.58%). However, local recall rate (18.53%) and further assessment rate (18.27%) were higher than recommended.The Chi square test showed a statistically significant difference (p<0.05) in recall rates between the compared age groups, as younger women (51-55 years) were more likely to have a negative diagnosis after the initial mammogram whereas older women (56-60 years) were more likely to be recalled. There was no age discrepancy (p>0.05) in local breast cancer detection rate and positive predictive value of screening test. Conclusion:Although the Maltese first screening round performed well, this study found deficiencies in recall and further assessment rates, which according to literature may result in psychological morbidity and inefficient use of screening resources. This study also concluded that when a cohort is analysed, age is not as significant as the screening round itself (first/subsequent). KeywordsBreast cancer, breast screening programme, screening performance parameter, false positive mammogram, age effect IntroductionBreast cancer is the most common cancer among Maltese women and accounts for a third of all female cancer deaths. Every one in twelve Maltese women will get breast cancer in her lifetime; a significantly higher proportion than the European average. 1 In October 2009, Malta's Department for Health agreed to implement a National Breast Screening Programme (MNBSP). 2 The aim of screening was to reduce morbidity and mortality from the disease without adversely affecting the health of participants. 3,4 Key to achieving this aim were high levels of quality within the entire screening process. 4 The MNBSP strives to protect the dignity and privacy of women, while offering an effective service at the highest levels of quality to diagnose and treat breast cancers at the earliest possible stage, and also meeting the European clinical standards. 4 The first MNBSP round commenced in October 2009 and ended in February 2013. The local screening programme provided free screening, every three years for all women aged 50 to 60, resident in the Maltese Islands. This age range was selected for the first screening round since this age group was deemed to be the 'most at risk'...

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Section: Discussioncontrasting

confidence: 76%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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A retrospective audit of the first screening round of the Maltese breast screening programme

2017

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“…Since demonstration of the efficacy of mammographic screening in randomised trials, many developed countries have initiated mammography screening programmes [1]. It has been observed, both in the trials and the screening programmes, that survival is much better in women with screen-detected cancers than in those with tumours detected symptomatically [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Population estimates of survival in women with screen-detected and symptomatic breast cancer taking account of lead time and length bias

Lawrence

Wallis²,

Allgood³

et al. 2008

Breast Cancer Res Treat

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Background Evidence of the impact of breast screening is limited by biases inherent in non-randomised studies and often by lack of complete population data. We address this by estimating the effect of screen detection on cause-specific fatality in breast cancer, corrected for all potential biases, using population cancer registry data. Methods Subjects (N = 26,766) comprised all breast cancers notified to the West Midlands Cancer Intelligence Unit and diagnosed in women aged 50-74, from 1988 to 2004. These included 10,100 screen-detected and 15,862 symptomatic breast cancers (6,009 women with interval cancers and 9,853 who had not attended screening). Our endpoint was survival to death from breast cancer. We estimated the relative risk (RR) of 10-year cause-specific fatality (screendetected compared to symptomatic cancers) correcting for lead time bias and performing sensitivity analyses for length bias. To exclude self-selection bias, survival analyses were also performed with interval cancers as the comparator symptomatic women. Findings Uncorrected RR associated with screen-detection was 0.34 (95% CI 0.31-0.37). Correcting for lead time, RR was 0.49 (95% CI 0.45-0.53); length bias analyses gave a range of RR corrected for both phenomena of 0.49-0.59, with a median of 0.51. Self-selection bias-corrected estimates yielded a median RR of 0.68. Interpretation After adjusting for various potential biases, women with screen-detected breast cancer have a substantial survival advantage over those with symptomatic breast cancer.

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The cumulative risk of false‐positive results in the Norwegian Breast Cancer Screening Program: Updated results

Román

Hubbard

Sebuødegård

et al. 2013

Cancer

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BACKGROUND: Some false-positive results are inevitable in mammographic screening, but the impact of false-positive findings on the program and the participants is a disadvantage of screening. The objective of the current study was to estimate the cumulative risk of a false-positive result over 10 biennial screening examinations and the cumulative risk of undergoing an invasive procedure with a benign outcome in women screened between the ages of 50 years to 69 years. METHODS: A retrospective cohort study was performed in 231,310 women aged 50 years to 51 years at the time of first mammography screening who underwent 715,311 screening mammograms in the Norwegian Breast Cancer Screening Program from 1996 through 2010. Generalized linear mixed models were used to estimate the probability of a false-positive screening result and to compute the cumulative false-positive risk for up to 10 biennial screening examinations. RESULTS: The cumulative false-positive risk after 20 years of biennial screening for women who initiated screening aged 50 years to 51 years was 20.0% (95% confidence interval [95% CI], 19.7%-20.4%). The cumulative risk of undergoing an invasive procedure with a benign outcome for the same group of women was 4.1% (95% CI, 3.9%-4.3%). The cumulative risk of undergoing a fine-needle aspiration cytology, core needle biopsy, or open biopsy with a benign outcome was 1.4% (95% CI, 1.3%-1.5%), 2.0% (95% CI, 1.9%-2.1%), and 0.16% (95% CI, 0.13%-0.19%), respectively. CONCLUSIONS: One in every 5 women will be recalled for further assessment with a negative outcome if they attend biennial mammographic screening between ages 50 years to 69 years. The risk of an invasive procedure with a benign outcome is approximately 4%. It is important to communicate the existence and extent of this risk to the target group and to reduce to a minimum the waiting times between screening and further assessment. Cancer 2013;119:3952-8.

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International comparison of performance measures for screening mammography: can it be done?

Cited by 83 publications

References 37 publications

A retrospective audit of the first screening round of the Maltese breast screening programme

A retrospective audit of the first screening round of the Maltese breast screening programme

Population estimates of survival in women with screen-detected and symptomatic breast cancer taking account of lead time and length bias

The cumulative risk of false‐positive results in the Norwegian Breast Cancer Screening Program: Updated results

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