Delayed breast cancer diagnosis after repeated recall at biennial screening mammography: an observational follow-up study from the Netherlands

Joost R. C. Lameijer,Adri C. Voogd,Ruud M. Pijnappel,Mireille J. Broeders,Lucien E. M. Duijm,Wikke Setz-Pels,Vivianne C. G. Tjan-Heijnen

doi:10.1038/s41416-020-0870-2

Abstract

BackgroundDelay in detection of breast cancer may worsen tumour characteristics, with progression of tumour size and a higher risk of metastatic lymph nodes. The purpose of this study was to investigate delayed breast cancer diagnosis after repeated recall for the same mammographic abnormality at screening.MethodsThis was a retrospective study performed in two cohorts of women enrolled in a mammography screening programme in the Netherlands. All women aged 50−75 who underwent biennial screening mammography either between January 1, 1997 and December 31, 2006 (cohort 1) or between January 1, 2007 and December 31, 2016 (cohort 2) were included.ResultsThe cohorts showed no difference in proportions of women with delayed breast cancer diagnosis of at least 2 years (2.2% versus 2.8%, P = 0.29). Most delays were caused by incorrect BI-RADS classifications after recall (74.2%). An increase in mean tumour size was seen when comparing sizes at initial false-negative recall and at diagnosis of breast cancer (P < 0.001).ConclusionsThe proportion of women with a long delay in breast cancer confirmation following repeated recall at screening mammography has not decreased during 20 years of screening. These delays lead to larger tumour size at detection and may negatively influence prognosis.

Highlights

Delay in detection of breast cancer may worsen tumour characteristics, with progression of tumour size and a higher risk of metastatic lymph nodes
Frequency of delayed breast cancer confirmation and tumour characteristics of invasive cancers with a diagnostic delay Focusing on a delay in breast cancer diagnosis of at least 2 years after the first recall, 2.2% (32/1421 women) who were diagnosed with breast cancer in cohort 1 experienced this delay, compared to 2.8% (98/3,511) in cohort 2 (P = 0.29)
This study describes the frequency of a delay in breast cancer diagnosis after repeated recall at screening mammography, as well as the tumour characteristics of these cancers, the causes of diagnostic delay and the frequency of this delay among hospitals

Summary

Introduction

Delay in detection of breast cancer may worsen tumour characteristics, with progression of tumour size and a higher risk of metastatic lymph nodes. CONCLUSIONS: The proportion of women with a long delay in breast cancer confirmation following repeated recall at screening mammography has not decreased during 20 years of screening. These delays lead to larger tumour size at detection and may negatively influence prognosis. Delay in the detection of breast cancer remains an important topic in health care, both for its frequency of occurrence and its possible negative effects on survival.[3,4,5,6,7,8] A delay in breast cancer diagnosis may worsen tumour characteristics, with a progression of tumour size and a higher risk of metastatic lymph nodes. Several causes for a delayed breast cancer diagnosis after recall at screening have been reported, including an improper classification of mammographic abnormalities at subsequent clinical breast imaging, communication errors between physicians, and sample errors at biopsy.[3,6,9]

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