Abstract
Objectives
Surrogate measures of screening performance [e.g. interval cancer (IC) proportional incidence] allow timely monitoring of sensitivity and quality. This study explored measures using large (T2+) breast cancers as potential indicators of screening performance.
Methods
The proportional incidence of T2+ cancers (observed/expected cases) in a population-based screening programme (Trento, 2001–2009) was estimated. A parallel review of ‘negative’ preceding mammograms for screen-detected T2+ and for all ICs, using ‘blinded’ independent readings and case-mixes (54 T2+, 50 ICs, 170 controls) was also performed.
Results
T2+ cancers were observed in 168 screening participants: 48 at first screen, 67 at repeat screening and 53 ICs. The T2+ estimated proportional incidence was 68% (observed/expected = 168/247), corresponding to an estimated 32% reduction in the rate of T2+ cancers in screening participants relative to that expected without screening. Majority review classified 27.8% (15/54) of T2+ and 28% (14/50) of ICs as screening error (P = 0.84), with variable recall rates amongst radiologists (8.8–15.2%).
Conclusions
T2+ review could be integrated as part of quality monitoring and potentially prove more feasible than IC review for some screening services.
Key Points
• Interval breast cancers, assumed as screening failures, are monitored to estimate screening performance
• Large (T2+) cancers at screening may also represent failed prior screening detection
• Analysis of T2+ lesions may be more feasible than assessing interval cancers
• Analysis of T2+ cancers is a potential further measure of screening performance
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Ciatto, S., Bernardi, D., Pellegrini, M. et al. Proportional incidence and radiological review of large (T2+) breast cancers as surrogate indicators of screening programme performance. Eur Radiol 22, 1250–1254 (2012). https://doi.org/10.1007/s00330-011-2355-4
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DOI: https://doi.org/10.1007/s00330-011-2355-4