Interval Cancers and Duty of Candour, a UK Perspective

Eleanor Cornford,Nisha Sharma

doi:10.1007/s12609-019-0304-4

Abstract

Purpose of ReviewInterval cancers are defined as a cancer presenting in the interval following a negative screen. Interval cancers are important because they reduce confidence in the screening programme and have relatively worse prognostic features than screen-detected cancers. This review will look at the rates of interval cancers in the UK Breast screening programme and other population-based breast screening programmes in Europe. It will discuss the latest UK classification and look at factors affecting interval cancer rates. It will examine the pathological features of interval cancers and their mortality impact. It will also discuss the introduction of Duty of Candour and its relevance and impact in breast screening.Recent FindingsIt will report on the effect of newer technologies on interval cancer rates.SummaryInterval cancers are not unexpected in population-based screening programmes. They are known to have relatively worse prognosis than screen-detected cancers and therefore the accurate monitoring of interval cancers is important both for quality improvement and education. The impact of newer technologies on interval cancer rates is currently limited as the studies are ongoing.

Highlights

An interval breast cancer is a cancer that is diagnosed in between screening episodes after a woman has received a “normal” result
This review will look at the rates of interval cancers in the UK Breast screening programme and other population-based breast screening programmes in Europe
Hoff et al looked at the mammographic features and found that in previous mammograms of cancers missed at full field digital mammography (FFDM) there was a nonsignificant trend towards a higher % of asymmetric densities (27 vs 10%, P = 0.007) and a lower % of calcifications (18 vs 34%, P = 0.185) compared with those missed at screen film mammography (SFM) [24]

Summary

Introduction

An interval breast cancer is a cancer that is diagnosed in between screening episodes after a woman has received a “normal” result. Within the act a “notifiable safety incident” means “any unintended or unexpected incident that occurred in respect of a service user during the provision of a regulated activity that, in the reasonable opinion of a health care professional, could result in, or appears to have resulted in—the death of the service user, where the death relates directly to the incident rather than to the natural course of the service user’s illness or underlying condition, or severe harm, moderate harm or prolonged psychological harm to the service user” [30] It became apparent very soon after the act was introduced that this would have a major potential impact on the breast screening programme, staff morale and recruitment as there was the perception by some NHS Hospitals that any interval breast cancer constituted a notifiable safety incident! It is still too early to assess what impact this legislation will have on the breast screening programme but certainly the PHE publications make it easier to ensure consistency across different units

Conclusions

Findings

30. CQC Regulation 20: Duty of Candour 2015 Information for all providers