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Related Experiment Videos

Classifying interval cancers

A A Duncan1, M G Wallis

  • 1Warwickshire, Solihull and Coventry Breast Screening Unit, Coventry and Warwickshire Hospital, UK.

Clinical Radiology
|November 1, 1995
PubMed
Summary

Classifying interval breast cancers is inconsistent across screening centers. Reviewing mammograms in isolation, rather than mixed with normal films, increased false negatives by 10%. A standardized consensus review method is recommended for quality assurance.

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Area of Science:

  • Radiology
  • Oncology
  • Public Health

Background:

  • Interval breast cancers, diagnosed between screening mammograms, lack a standardized classification method.
  • Classification of interval cancers is a quality assurance (QA) standard for the National Health Service Breast Screening Programme (NHSBSP).
  • Current practices for reviewing interval cancers vary significantly among UK screening centers.

Purpose of the Study:

  • To investigate the methods used by different UK breast screening centers for classifying interval cancers.
  • To compare the impact of different review methods on the classification of interval cancers, specifically false negative rates.
  • To propose a standardized method for interval cancer review to improve consistency and comparability.

Main Methods:

  • A questionnaire was distributed to 17 UK regional breast screening QA centers to assess their interval cancer review protocols.
  • A simulated film viewing exercise was conducted with six radiologists reviewing 50 interval cancers using three distinct methods: isolated review, mixed with screening films, and consensus review.
  • False negative classifications were determined based on whether abnormalities were identified by one, a majority, or all reviewing radiologists.

Main Results:

  • Eighty percent of responding centers had a formal interval cancer review method, but only 33% simulated screening conditions.
  • Reviewing interval cancers in isolation, compared to mixed with normal screening films, increased false negative classifications by 10%.
  • False negative rates varied widely (4% to 56%) depending on the consensus criteria used.

Conclusions:

  • The method of reviewing mammograms significantly impacts the classification of interval breast cancers, particularly false negative rates.
  • A lack of standardized review protocols hinders consistent quality assurance and inter-center comparisons within the NHSBSP.
  • A recommended standard review method involves mixing interval cancer films with normal screening films and utilizing a consensus opinion from at least three external reviewers.

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