OAK BROOK, Ill. – Lower screening mammography recall rates — the rates at which women are called back for additional testing based on suspicious findings — are associated with higher rates of breast cancers detected between screenings, or interval cancers, according to a major new study published online in the journal Radiology. Researchers said the study shows that establishing a minimum recall rate is a reasonable and potentially important goal for breast cancer screening programs.
Recall for additional testing after mammography is an important safeguard against missing invasive breast cancers, but the practice carries costs, including anxiety for the patient and additional expenses to the healthcare system. In order to minimize these costs, breast cancer screening programs routinely specify maximum recall rates after screening mammography.
The U.K. has established a maximum recall rate target of less than 7 percent for a patient’s first screening, also known as a prevalent screen, and less than 5 percent for incident screens, or those in which previous screening results exist. However, no such consensus exists as to a minimum recall rate, below which additional cancers would be missed.
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To learn more about the potential trade-offs between lower recall rates and interval cancers, Elizabeth S. Burnside, M.D., MPH, from the University of Wisconsin School of Medicine and Public Health in Madison, Wis., and Stephen W. Duffy, B.Sc., M.Sc., from Queen Mary University of London, and colleagues analyzed 5,126,689 screening episodes, or the period during which a set of breast screening activities for an eligible woman takes place, from 84 screening facilities in the U.K. National Health Service Breast Screening Program (NHSBSP). Data were drawn from a 36-month period with a three-year follow-up in women ages 50 to 70 years.
Recall rate averaged 4.56 percent, with an interval cancer rate of 3.1 per 1,000 women screened. Interval cancers are associated with a worse prognosis than screen-detected cancers.
Lower recall rates correlated with higher interval cancer rates. The researchers estimated that, in aggregate, 80 to 84 additional recalls would be required to avoid one interval cancer, a ratio that varied based on age group and prevalent screens versus incident screens.
Screening mammography outcomes based on age demonstrated that both cancer detection rates and interval cancer rates were lower in younger age groups as expected, based on underlying breast cancer incidence according to age.