Classification of findings in mammography screening - A method to minimise recall anxiety?

Abstract

Study objective-The aim was to find out if it is possible, by classifying screening mammograms according to the likelihood of malignancy, to divide the recalled women to a group in which there is high suspicion of malignancy, most having breast cancers, and a group with more obscure findings. Design-Screening mammograms of recalled women were classified according to the likelihood of malignancy. 0=technically insufficient, 1=normal, 2=benign tumour, 3= malignancy cannot be excluded, 4=strongly suspicious for malignancy, 5=malignant. Setting-This study was a population based survey of mammography screening in Helsinki and surroundings in Finland. Patients-21,417 women (aged 50-59 years) were invited to be screened, 18,012 (84.10%) participated. Of these 579 (3.21% of those screened) were recalled for further studies; 124 of these were referred for surgical biopsy and 82 had breast cancer. Measurements and main results-All cases classified as 5, 60% of the cases classified as 4, 6.5% of the cases classified as 3, 0% of the cases classified as 2 or 1, and 1.2% of the cases classified as 0 proved to have breast cancers. However classification 5 represented 5.9% of all recalled women and 41.5% of all screening detected breast cancers; classification 4, 6.0% of all recalled women and 25.6% of all screening detected breast cancers; classification 3, 68.9% of all recalled women and 31.7% of all screening detected breast cancers; classification 2, 11.7% and classification 1, 2.9% of all recalled women. No breast cancers were detected with these classifications. Classification 0 represented 4.5% of all recalled women and 1.2% of all screening detected breast cancers. Classifications 5 and 4 represented only 11.9% of all recalled women but 67.1% of all screening detected breast cancers. Conclusions-By classifying screening mammograms according to the likelihood of malignancy, recalled women can be divided into two groups: (1) a quite small subgroup in which everyone or almost everyone will be shown to have breast cancer; and (2) a much larger subgroup in which only a few will be proven to have breast cancer. The invitation procedure for the further studies should be improved on this basis of minimising anxiety among recalled women.