Purpose Problem solving magnetic resonance imaging (MRI) is used to exclude malignancy in women with equivocal findings on conventional imaging. However, recommendations on its use for women recalled after screening are lacking. This study evaluates the impact of problem solving MRI on diagnostic workup among women recalled from the Dutch screening program, as well as time trends and inter-hospital variation in its use. Methods Women who were recalled at screening mammography in the South of the Netherlands (2008–2017) were included. Two-year follow-up data were collected. Diagnostic-workup and accuracy of problem solving MRI were evaluated and time trends and inter-hospital variation in its use were examined. Results In the study period 16,175 women were recalled, of whom 906 underwent problem solving MRI. Almost half of the women (45.4%) who underwent problem solving MRI were referred back to the screening program without further workup. The sensitivity, specificity, and positive and negative predictive values of problem solving MRI were 98.2%, 70.0%, 31.1%, and 99.6%, respectively. The percentage of recalled women receiving problem solving MRI fluctuated over time (4.7%–7.2%) and significantly varied among hospitals (2.2%–7.0%). Conclusion The use of problem solving MRI may exclude malignancy in recalled women. The use of problem solving MRI varied over time and among hospitals, which indicates the need for guidelines on problem solving MRI.

Although malpractice lawsuits are frequently related to a delayed breast cancer diagnosis in symptomatic patients, information on claims at European screening mammography programs is lacking. We determined the type and frequency of malpractice claims at a Dutch breast cancer screening region. We included all 85,274 women (351,009 screens) who underwent biennial screening mammography at a southern breast screening region in The Netherlands between 1997 and 2009. Two screening radiologists reviewed the screening mammograms of all screen detected cancers and interval cancers and determined whether the cancer had been missed at the previous screen or at the latest screen, respectively. We analyzed all correspondence between the screening organization, clinicians and screened women, and collected complaints and claims until September 2011. At review, 20.9% (308/1,475) of screen detected cancers and 24.3% (163/670) of interval cancers were considered to be missed at a previous screen. A total of 19 women (of which 2, 6 and 11 women had been screened between 1997 and 2001 (102,439 screens), 2001 and 2005 (114,740 screens) and 2005 and 2009 (133,830 screens), respectively) had contacted the screening organization for additional information about their screen detected cancer or interval cancer, but filed no claim. Three other women directly initiated an insurance claim for financial compensation of their interval cancer without previously having contacted the screening organization. We conclude that screening-related claims were rarely encountered, although many screen detected cancers and interval cancers had been missed at a previous screen. A small but increasing proportion of women sought additional information about their breast cancer from the screening organization.Many countries have introduced screening mammography programs with the aim to reduce breast cancer mortality. 1 Essential for reducing morbidity and mortality is the early detection of breast cancers, as a diagnostic delay lowers breast-conserving treatment options and worsens prognosis. 2,3 Unfortunately, a delayed diagnosis resulting from a missed cancer at screening is not rare. Certain cancers are just not visible at screening mammography, whereas others are misinterpreted or overlooked. 4,5 Interpretation of mammograms is one of the most difficult tasks in radiology and the sensitivity of screening mammography for breast cancer detection ranges from 70% to 80%. 6,7 Nevertheless, the public's expectations of the efficacy of screening mammography are high, and diagnostic errors can have major legal consequences for the screening radiologist.An Italian study observed, over a period of 12 years, a marked rise in malpractice claims related to diagnostic mammography in symptomatic women. 8 In the United States, a delay in breast cancer diagnosis is nowadays the most prevalent and the second most expensive condition resulting in malpractice lawsuits. 9,10 The most common defendant in these lawsuits is the interpreting radiologist and as a consequence the ...

Few data are available on the effect of previous benign breast surgery on screening mammography accuracy. We determined whether sensitivity of screening mammography and tumor characteristics are different for women with and without previous benign breast surgery. We included a consecutive series of 317,398 screening mammograms of women screened between 1997 and 2008. During 2-year follow-up, clinical data, breast imaging, biopsy and surgery reports were collected from women with screen-detected or interval breast cancers. Screening sensitivity, tumor biology and tumor stages were compared between 168 women with breast cancer and prior ipsilateral benign breast surgery and 2,039 women with breast cancer but without previous ipsilateral, benign breast surgery. The sensitivity of screening mammography was significantly lower for women with prior surgery [64.3% (108/168) versus 73.4% (1,496/2,039), p 5 0.01]. The concomitant increased interval cancer risk remained significant after logistic regression adjustment for age and breast density (OR 5 1.5, 95% CI: 1.1-2.1). Comparing screen-detected cancers in women with and without prior breast surgery, no significant differences in estrogen receptor status (p 5 0.56), mitotic activity (p 5 0.17), proportions of large (T21) tumors (p 5 0.6) or lymph node positive tumors (p 5 0.4) were found. Also for interval cancers, no differences were found in estrogen receptor status (p 5 0.41), mitotic activity (p 5 0.39), proportions of large tumors (p 5 0.9) and lymph node positive tumors (p 5 0.5) between women with and without prior breast surgery. We conclude that sensitivity of screening mammography is significantly lower in women with previous benign breast surgery than without, but tumor characteristics are comparable both for screen detected cancers and interval cancers.Mammography screening aims to detect breast cancer at an early stage and several studies have shown that screening significantly reduces breast cancer mortality.1-3 Many countries have introduced regional or nationwide breast cancer screening programs in the last two decades. The Netherlands has a long history of screening mammography and their nationwide breast cancer screening program offers biennial screening mammography for women aged 50-75 years.Breast conserving treatment for breast cancer may cause rigorous mammographic changes, due to surgery and radiation therapy. [4][5][6] These changes frequently hamper the mammographic interpretation and may result in a lower sensitivity of mammography for breast cancer detection. On the other hand, post-treatment changes may simulate breast cancer at mammography and lead to an increase of false positive assessments and thus a lower specificity. The Dutch guidelines on breast cancer screening advise that mammographic follow-up for women after breast conserving therapy should take place in an outpatient hospital setting for a period of 5-10 years before returning to routine screening. 7Mammographic alterations occurring after breast surgery for benign disease and r...