Clinical Factors Associated with Asymptomatic Women Having Inconclusive Screening Mammography Results: Experiences from a Single Medical Center in Taiwan

Abstract

Screening mammography is used worldwide for the early detection of breast cancer in women experiencing no symptoms. The Breast Imaging Reporting and Database System (BI-RADS) is used to report mammographic findings. However, little is known about the clinical characteristics of Asian women with BI-RADS category 0, and we aimed to explore such characteristics in the context of Taiwan. This retrospective cross-sectional study was conducted using data from a single tertiary medical center. We examined the association of blood test data and estrogen exposure–related medical histories with BI-RADS reports from screening mammography of 4280 women between 1 January 2010 and 31 July 2019. The data of 4280 participants were evaluated, and they were categorized into BI-RADS category 0 (n = 413; 9.6%) and 1–5 (n = 3867; 90.4%) subgroups. In a multivariate analysis, breast surgery history and premenopausal status had a positive relationship with a category 0 status, with respective risk increases of 64% and 34% (p = 0.010 and 0.013). Hormone contraceptive use for ≥5 years was a negative independent predictor of having a category 0 status. In conclusion, breast surgery history and premenopausal status significantly increased the likelihood of individuals having incomplete mammographic findings, even when they were older than 45 years. Identifying related factors before screening mammography is helpful for clinical physicians to arrange more proper and alternative examination and obtain a definite diagnosis.

Bridging Gaps: Analyzing Breast Imaging-Reporting and Data System (BI-RADS) 0 Rates and Associated Risk Factors in Disproportionally Affected Communities

“…Additionally, a study in Taiwan found that the proportion of women with BI-RADS 0 classification was higher for women with premenopausal status, a history of breast surgery, and less than two abortions reported [9], aligning with our findings.…”

“…A study in Nigeria [ 13 ] reported that high breast density was higher in subjects with inconclusive reports than those with low breast density. Additionally, a study in Taiwan found that the proportion of women with BI-RADS 0 classification was higher for women with premenopausal status, a history of breast surgery, and less than two abortions reported [ 9 ], aligning with our findings.…”

“…In Nigeria, a study of diagnostic mammography revealed an association between high breast density and inconclusive outcomes [13]. Yet, these findings contrast with a Taiwanese study that failed to find that breast density was associated with BI-RADS categorization [9]. Furthermore, a retrospective study in Delhi, India, emphasized that improper breast positioning, identified in 2.9% of mammograms, was linked to decreased sensitivity and increased inconclusive results [14].…”

“…Negative test results include BI-RADS 1, a normal finding, and BI-RADS 2, findings that are not cancerous, such as benign calcifications, masses, or lymph nodes in the breast [ 8 ]. Mammography results are sometimes considered to have a BI-RADS category of 0, meaning their mammography results are inconclusive and require further diagnostic testing [ 9 ]. Findings of BI-RADS 0 might lead to patient stress, increased costs, a low rate of patient satisfaction, and a low likelihood of return for routine breast cancer screening in the next year [ 10 ].…”