During 1989 and 1990, 25,788 screening and 1,077 diagnostic breast imaging examinations were performed. Audit was performed in 6-month intervals to allow comparison of performance over time. Sensitivity, positive predictive value, and stage of disease were determined for each radiologist, for patients over and those under 50 years of age, and for patients with and for those without a suspect palpable breast abnormality. In the screening portion of the study, 1,539 of 25,788 (5.9%) patients were asked to return for diagnostic breast imaging, 119 of 188 (63%) cancers were stage 0 or stage 1 disease, and a sensitivity of 91% and a positive predictive value of 11% were found. If patients with a palpable breast abnormality were eliminated, 103 of 138 (75%) patients had disease that was less than stage 2. In the diagnostic portion of the study, 296 of 1,077 (27%) patients were referred for biopsy and 53 of 71 (75%) cancers were stage 0 or stage 1 disease. A sensitivity of 97% and a positive predictive value of 24% were found. If patients with a palpable breast abnormality were eliminated, 51 of 63 (81%) patients had disease that was less than stage 2.

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The authors prospectively assessed the effectiveness of requests for immediate additional evaluation or biopsy made on the basis of the interpretation of abnormal findings on screening mammograms. In 1,125 screening mammograms obtained in asymptomatic women referred by physicians, the findings in 63 (6%) were interpreted as requiring additional imaging or biopsy. Written reports were sent, and in all cases the office of the referring physician was notified directly by phone. Physicians were periodically contacted if no follow-up had been performed to resolve the questioned abnormality. In the first 2.5 months, no action had been taken in 40 of 63 (63%) of the recommendations. After additional calls, this diminished to 10 of 63 (16%) at 3.5 months, but at 4.5 months four of 63 (6%) patients had not undergone the recommended additional studies. These results suggest the need for development of systems to ensure prompt action in patients with abnormal findings at mammographic screening.

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