Symptomatic women with normal screening mammograms: is assessment by the breast screening programme justifiable?

Since the commencement of screening in 1988, the West of Scotland Breast Screening Programme has invited women with symptoms, but normal screening mammograms, for assessment. This paper reviews the results of 344 such assessments. Malignancy was detected in three patients; two had invasive carcinoma and one Paget's disease of the nipple. One woman underwent a benign excision biopsy. Three women returned to routine recall were subsequently diagnosed with breast cancer; one had Paget's disease, a second developed a true interval cancer, and a third a screen detected cancer six years later. Cancer detection rate in this group of women was approximately 1% in those assessed. The two women with invasive breast carcinomas had dense breasts and one view only was taken on screening. No cancers were detected in women complaining of lumps or dimpling who had normal fatty or mixed density mammograms.