Abstract
IntroductionInterval breast cancers occur following a negative breast screening mammogram and before the next scheduled appointment within screening programmes. Radiological review classifies them as cancers that develop between screens, cancers with no obvious malignant abnormalities on prior screens or cancers not detected at screening. This study aimed to systematically review published literature on the occurrence of open disclosure following interval cancer radiological reviews by breast screening programmes internationally in a retrospective setting and examine methodologies used for radiological reviews for the purposes of disclosure. MethodsA search for relevant articles published (January 2000 – May 2019) was conducted according to PICO and PRISMA guidelines. The databases Pubmed, Scopus, Google Scholar, Cinahl, Web of Science, Embase, Science Direct and Global Health were searched. Relevant studies were reviewed if they had completed a retrospective review and classification of interval breast cancers. ResultsOf 46 relevant articles included, no study was identified that conducted a retrospective review purposely for open disclosure. Retrospective reviews were conducted for audit/quality assurance, and research including for radiologist education and learning. Variation in methodology was found across review type (non-blinded/semi-informed approach), number of reviewers and classification categories. The proportion of false negative cancers classified among the studies ranged from 4 to 40 %. DiscussionVariation among radiological review practices were observed, which likely impacts classification results. To ensure standardised classification of interval breast cancers are employed for the purposes of open disclosure in screening settings, reproducible and consistent methodology is required.
Highlights
Interval breast cancers occur following a negative breast screening mammogram and before the scheduled appointment within screening programmes
This study aimed to examine methodologies from published literature used for radiological reviews and to determine the practices used for disclosure of the review findings to interval cancer patients among international population-based breast screening programmes
The main aim of the study was not related to disclosure of the interval cancer radiological reviews, the authors noted that when a false negative interval cancer is identified, “to acknowledge this, the programme currently invites women based on informed consent and literature that accompanies appointments specifies that not all cancers are visible on a mammogram or detected by film readers” [18]
Summary
Interval breast cancers occur following a negative breast screening mammogram and before the scheduled appointment within screening programmes. As outlined in the European breast screening guidelines, interval breast cancers can be classified following diagnosis into sub types, depending on their radiological appearance on prior screening mammograms, upon review This classification includes true intervals, minimal signs, occult cancers and false negative cancers [1,3]. False negative include cancers where ‘an abnormality is clearly visible and warrants assessment’, where the cancer was missed and should have been detected [1] To determine these subtypes, classification of interval cancers is required and occurs in retrospect after the interval cancer diagnosis, by comparing the diagnostic to the prior negative screening mammogram. Many factors can influence this classification and there are many challenges with conducting a retrospective review including the presence of hindsight bias and lack of standardised methodology For this reason, classification of interval cancers is typically not routinely monitored as a quality assurance standard across most screening programmes [4]
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