Mammography screening in the Netherlands: delay in the diagnosis of breast cancer after breast cancer screening

Duijm, Luciën E. M.; Groenewoud, Johanna H.; Jansen, Frits H.; Fracheboud, Jacques; Beek, M. van; Koning, Harry J. de

doi:10.1038/sj.bjc.6602158

Cited by 58 publications

(43 citation statements)

References 22 publications

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“…van Dijck et al (1993) showed that a considerable percentage of interval cancers in a biennial screening programme appear de novo between two screening rounds. We related screening outcome parameters to the total breast cancer incidence after 2 years of follow-up rather than after 1 year of follow-up, as this will provide full information about the interval cancer rate and the total costs of follow-up in a biennial screening programme (Duijm et al, 2004b(Duijm et al, , 2008. Review of late interval cancers is part of the quality assurance and evaluation of the Dutch breast cancer screening programme.…”

Section: Discussionmentioning

confidence: 99%

“…For all women with a screening mammogram that was considered positive by at least one of the radiologists or radiographers, we collected data on diagnostic procedures undertaken, breast cancer diagnosis, histopathology, and TNM (tumour -node -metastases) classification (UICC, 1987) to identify screen-detected cancers. Procedures for the detection of interval cancers (interval cancers are breast cancers that are diagnosed in women after a negative screening examination) have been described previously (Duijm et al, 2004b). To determine whether an interval cancer could potentially have been a screen-detected cancer if all positive radiographer readings had been referred, we investigated if the mammographic abnormalities on the diagnostic films corresponded to any abnormalities registered by the radiographers at screening.…”

Section: Screening Follow-upmentioning

confidence: 99%

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Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome

et al. 2009

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We prospectively determined the variability in radiologists' interpretation of screening mammograms and assessed the influence of type and number of readers on screening outcome. Twenty-one screening mammography radiographers and eight screening radiologists participated. A total of 106 093 screening mammograms were double-read by two radiographers and, in turn, by two radiologists. Initially, radiologists were blinded to the referral opinion of the radiographers. A woman was referred if she was considered positive at radiologist double-reading with consensus interpretation or referred after radiologist review of positive cases at radiographer double-reading. During 2-year follow-up, clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result from any reader. Single radiologist reading (I) resulted in a mean cancer detection rate of 4.64 per 1000 screens (95% confidence intervals (CI) ¼ 4.23 -5.05) with individual variations from 3.44 (95% CI ¼ 2.30 -4.58) to 5.04 (95% CI ¼ 3.81 -6.27), and a sensitivity of 63.9% (95% CI ¼ 60.5 -67.3), ranging from 51.5% (95% CI ¼ 39.6 -63.3) to 75.0% (95% CI ¼ 65.3 -84.7). Sensitivity at non-blinded, radiologist double-reading (II), radiologist double-reading followed by radiologist review of positive cases at radiographer double-reading (III), triple reading by one radiologist and two radiographers with referral of all positive readings (IV) and quadruple reading by two radiologists and two radiographers with referral of all positive readings (V) were as follows: 68.6% (95% CI ¼ 65.3 -71.9) (II); 73.2% (95% CI ¼ 70.1 -76.4) (III); 75.2% (95% CI ¼ 72.1 -78.2) (IV), and 76.9% (95% CI ¼ 73.9 -79.9) (V). We conclude that screener performance significantly varied at singlereading. Double-reading increased sensitivity by a relative 7.3%. When there is a shortage of screening radiologists, triple reading by one radiologist and two radiographers may replace radiologist double-reading.

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Section: Discussionmentioning

confidence: 99%

Section: Screening Follow-upmentioning

confidence: 99%

Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome

et al. 2009

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“…7,9 There may also be diagnostic delays, e.g., due to erroneous mammographic interpretations. 21 In the current study, any follow-up screening or early recall was discouraged but, if existing, not necessarily captured. This may affect comparability of the Finnish interval cancer rates with other studies.…”

Section: Discussionmentioning

confidence: 99%

Episode sensitivity in association with process indicators in the Finnish breast cancer screening program

Sarkeala

Hakama

Saarenmaa

et al. 2005

Intl Journal of Cancer

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We assessed the episode sensitivity of the Finnish mammography program for women aged 50-59 (partly 60-64) years and explored associations between the episode sensitivity and the screening process indicators from 1991 to 1999. For the study period, data were available from 10 screening centers. Records of 721,000 screening visits were linked to the files of the nationwide Finnish Cancer Registry from 1991 to 2001 at an individual level. The rates of screen-detected and interval breast cancers were calculated at the first and at the subsequent screens. The episode sensitivity was determined by contrasting the incidence of interval cancers with the expected population incidence rate without screening (incidence method) and as a proportion of interval cancers out of all cancers detected (detection method). At the subsequent screens, the episode sensitivity determined by the incidence method was 54% and by the detection method 65%. The sensitivity 0-11 and 12-23 months after the screening was 70% and 38%, respectively. The episode sensitivity decreased toward the end of the study period and increased with age. The center-specific sensitivity increased 13% per 1% absolute increase in the recall rate. In general, our study provides further information on the effectiveness of screening programs. The sensitivity estimates were comparable with those from other European service screening programs. The variability in the episode sensitivity suggests potential for variations in the future screening outcome. ' 2005 Wiley-Liss, Inc.

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“…Positive matches are manually checked to determine whether they involve an IC or a late diagnosis of a screen-detected (SD) cancer due to a delay during the diagnostic assessment. 22 The Dutch programme evaluation takes the loss to follow-up into account for women who died or moved away from their region before their next screening examination, and also the exact date of the next screening examination. 10 IC rates are then expressed as the number of IC divided by the number of women-years of follow-up within the corresponding time period.…”

Section: Methodsmentioning

confidence: 99%

Methodological issues in international comparison of interval breast cancers

Bulliard

Sasieni

Klabunde

et al. 2006

Intl Journal of Cancer

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International comparisons of interval cancers (IC) are important to better understand the relationship between programmes' performance and screening practices. In this respect, differences in (i) definition, (ii) identification and (iii) quantification of IC have received little attention. To examine these 3 comparability issues and activities involving IC, an assessment was conducted among member countries of the International Breast Cancer Screening Network, and the impact of accuracy of identification and quantification practices was estimated using 1996-98 data from the Dutch breast cancer screening programme. Information was obtained from 19 screening programmes in 18 countries, 16 of which acknowledged the coexistence of opportunistic screening. IC data were collected to evaluate performance of the screening programme (100% of programmes) and the radiologists (89%); 53% of programmes had a designated review process for IC. Most programmes (84%) agreed with the European Guidelines definition of IC, but a case situation exercise evidenced substantial discrepancy in classification of cancers that occurred after a positive screen. Completeness of identification of IC appears to contribute most to international variation, and cannot be easily controlled for in methodologically rigorous comparisons. Statistically significant differences of about 4% were measured between quantification methods for IC. An operational definition of IC is proposed to enhance international comparability. Valid comparisons of IC are possible with careful attention to the definition but true differences in IC frequency across screening programmes should exceed 10% to be possibly indicative of real differences between programmes. ' 2006 Wiley-Liss, Inc.Key words: mammography; mass screening; interval cancer; international collaboration; comparative study Although mammography is currently the only proven screening method for reducing mortality from breast cancer, 1-3 some breast cancers will inevitably elude screening detection. Interval cancers (IC) are those tumours that are diagnosed in the time period between 2 screening rounds. They occur because of the following: rapid tumour growth leads to cancers that truly develop in the interval after screening, cancers that are present are masked by characteristics of the breast or the cancer, readers miss subtle or minimal signs on the screening mammogram, or further assessment procedures fail to diagnose the cancer radiologically detected. 4,5 From a population-based perspective, IC are a key measure of the quality of the radiology performed and of the early impact of screening programmes. 6 A high incidence of IC adversely affects the ability of a screening programme to reduce mortality from breast cancer. Knowledge of IC is also necessary to determine the sensitivity of the programme and of the radiologists' performance.The frequency of IC has been assessed in randomised studies and in established programmes that provide mammography to a defined target group (service screening), and compa...

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Mammography screening in the Netherlands: delay in the diagnosis of breast cancer after breast cancer screening

Cited by 58 publications

References 22 publications

Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome

Inter-observer variability in mammography screening and effect of type and number of readers on screening outcome

Episode sensitivity in association with process indicators in the Finnish breast cancer screening program

Methodological issues in international comparison of interval breast cancers

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