Follow-Up of BI-RADS 3 Breast Mammograms, Results of a West France “Departement” Breast Cancer Screening Programme.

Abstract

Background: French breast cancer screening program lies on a decentralized system. Each administrative division of a region (departement) organizes, coordinates and assesses their programme under the aegis of the French National Cancer Institute (INCa).The screening programme includes every two years, for women between 50 and 74 years of age a clinical examination and a breast mammogram. Conclusions are reported using the Breast Imaging and Reporting Data System (BI-RADS) of the American College of Radiology (ACR).French recommendations for low-suspicion lesions of the breast (BI-RADS 3) consist in a new screening 4 or 6 months later, then another one at one year and a third one year later before returning to the breast screening programme.Objectives: To evaluate the medical organisation and patients' observance for the follow-up of low suspicion breast lesions (BI-RADS 3).Material and Methods: Between January 2005 and January 2007 every BI-RADS 3 breast mammogram exams were listed in our departement and each radiologist was asked about their patient's health status.Patients who had not had their control mammogram were contacted.Their general practitioners were asked in case of no response.Results: Between January 2005 and January 2007 126 385 women were invited to take part in the breast cancer screening programme (screening rate 59.55%).2 209 exams were considered BI-RADS 3 (2.90%).383 patients (17.5%) were lost of sight.2111 women underwent an ultrasound scan examination (40.67%).20 women had MRI (0.39%).182 had biopsies (8.23%).BI-RADS 3 predictive value for a breast cancer lesion was 3.35%.Control mammograms were proposed at 4 months for 339 patients (18.7%) and 6 months for 1 125 patients (62.1%).1247 patients had only one control mammogram (60.9%), 388 (18.9%) patients had two and 60 (2.9%) had at least 3 controls.47.2% of BI-RADS 3 was re classified after first control and 60% after second control.Patients' observance was 91.26% for the first control, 62.9% for the second and decreased to 27% at fourth.1226 (55.5%) were re classified BI-RADS 1 or 2.185 (8.4%) were up graded to BI-RADS 4 or 5.154 (7%) are on attempt of re classification, 152 (6.90%) had no definitive conclusion after 24 months and 109 (4.90%) declined the medical follow-up supervision.The median time needed for re classified BI-RADS 3 was 276 days.Discussion: Our BI-RADS 3 rate (2.90%) is similar to those already published (3-7.7%).French recommendations are applied for the first and second control.Our cancer rate for BI-RADS 3 lesions (3.35%) is higher than those published (0.3%-1.7%).Patients' observance decreases rapidly, and patients' loss-of-sight remains high (17.3%).Initial BI-RADS 3 classification must be improved and recommendations for follow-up may be modified into a delayed control at 9 months that could settle for a BI-RADS 2 classification or lead to a histopathological exam.Waiting for new recommendations, we now contact each woman with BI-RADS 3 one month before control and in the absence of control we contact radiologist and general practitioner to improve observance and reduce the number of lost-of-sight patients. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4013.

Underestimation of Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Stereotaxic 11-Gauge Vacuum-Assisted Breast Biopsy

“…Recently, several authors (26) analyzed the incidence of malignancy in patients diagnosed with lobular neoplasia (B3) on core needle biopsy (CNB) of breast lesions and found a significant underestimation of malignancy in patients with this kind of lesion. Moreover, other works (27)(28)(29)(30) emphasize the heterogeneity of B3 lesions and the likelihood of malignancy for these lesions, underlining new patient pathways for their management.…”