The identification of false negatives in a population of interval cancers: a method for audit of screening mammography

Simpson, W.; Neilson, F.; Young, J. R.

doi:10.1016/0960-9776(95)90074-8

Cited by 23 publications

(9 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our frequency of false negative cancers, 19% of classifiable cases, is comparable with other series [11,12]. The simple user interface allowing the ''point and click'' is very easy to use on a practical Interval cancer geography: a database level.…”

Section: Discussionsupporting

confidence: 74%

Geographical distribution of breast cancers on the mammogram: an interval cancer database

Brown

Eccles²,

Wallis³

2001

BJR

View full text Add to dashboard Cite

Auditing interval cancers is an important part of a breast screening radiologist's continuing education. We set out to determine whether the position of interval cancers on the mammogram differs from those detected at screening. The 773 interval cancers so far identified, and the first 200 screen detected cancers, have been entered onto a Microsoft Access 97 database developed to record pathological and radiological features, including the position of the cancer on a stylized diagram using a "point and click" system. Reports were generated showing positions of all interval cancers by classification and reader. The distribution of true interval cancers is statistically different from screen detected cancers on both views. The distribution of the false negative and screen detected cancers only differs on the oblique view. False negative and true interval cancers are of the same distribution on both craniocaudal and oblique views. However, these differences do not appear to be practically useful when applied to individual readers. We have developed a database that allows systematic recording of pathological and radiological information regarding breast cancers. Additionally, it can record the geographic position of the cancer with minimal memory requirements. Statistical differences in the distribution of false negative and screen detected cancers have been demonstrated and the stylized diagrams reinforce the importance of the conventional review areas. Although this has not identified any "blind spots" in our own readers, it nevertheless provides film readers with a tool to audit their own work.

show abstract

Section: Discussionsupporting

confidence: 74%

Geographical distribution of breast cancers on the mammogram: an interval cancer database

Brown

Eccles²,

Wallis³

2001

BJR

View full text Add to dashboard Cite

show abstract

“…The proportions of true interval cancers (49 %), overlooked tumours (19 %), misinterpreted tumours (6 %), occult 3 80 32 1 21 22 3 13 44 Spiculated mass a 8 94 39 1 44 44 1 12 36 Calcifications 6 11 6 0 5 5 0 0 0 Non-specific density a 15 30 17 2 17 19 0 5 14 Architectural distortion 3 7 4 4 7 cancers (10 %) and 16 % not classifiable tallied with other reports where similar criteria for categorisation of interval cancers have been used [18]. The somewhat better survival in occult cancers (pairwise comparisons with true interval cancers P = 0.053 and with missed tumours P = 0.244) may possibly be explained by differences in age, tumour size and histopathological classification (Fig.…”

Section: Discussionsupporting

confidence: 53%

“…The interval cancers constitute ca. 20±30 % of breast cancers [1,3,18], giving an even lower (possibly three to five times lower) positive predictive value for an interval cancer. It implies that it would be necessary to recall 100±400 women for complete mammography often complemented by clinical examination and biopsy in order to detect, in the course of screening, one single additional breast cancer that would otherwise emerge during the following interval.…”

Section: Discussionmentioning

confidence: 99%

Invasive interval cancers in the ÖstergÖtland Mammographic Screening Programme: radiological analysis

Viták

1998

European Radiology

View full text Add to dashboard Cite

The aim of this study was to find out by radiological analysis whether it is possible to prevent interval cancers in screening programmes without a concomitant increase in false positives. Re-scrutiny of all mammograms of 544 interval cancers was implemented. Blinded re-scrutiny of screening mammograms of 390 interval cancers mixed with other cases (prevalence of detectable cases 37 %) by two outside radiologists was also carried out. True interval cancers constituted 49 %, missed tumours 25 %, occult tumours 10 % and unclassifiable cases 16 %. There were no significant differences in survival between true interval cancers, overlooked or misinterpreted cancers, and mammographically occult cancers. In the blinded re-scrutiny both examiners reached a positive predictive value for malignancy of 67 %, and a sensitivity of 69 % and 81 %, respectively. In a screening programme such as this, it was estimated that 100-400 additional women would have to be recalled from screening for further workup in order to detect each additional cancer which would otherwise emerge as an interval cancer. The occurrence of interval cancer increased with age and was influenced by the design of screening. The proportion of patients with potential iatrogenic delay in diagnosis (overlooked and misinterpreted cancers) was equivalent to figures from other studies. There were no significant differences in survival between the various categories of interval cancer. The study confirmed the association of criteria for referral for further investigation with the number of false positives. Efforts to reduce the number of interval cancers by lowering the threshold for recall are likely to be counterproductive.

show abstract

“…Their analysis of 167 interval cancers showed 46% 'true intervals', 26% 'false-negatives', 11% 'occult', and 16% 'not classifiable'. 11 A review of screening mammograms from the Nottingham Breast Screening Unit also found similar rates (22% false-negative, 8% occult, 57% true interval cancers, out of 90 interval cancers found). In short, these studies emphasise that not all missed diagnoses are 'screening mistakes', and not every cancer diagnosed between screening tests is a 'false-negative'.…”

Section: Estimating and Detecting False-negatives In Screeningmentioning

confidence: 82%

False-negative results in screening programmes: systematic review of impact and implications.

Petticrew

Sowden²,

Lister-Sharp³

et al. 2000

Health Technology Assessment

178

View full text Add to dashboard Cite

Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA web site (see overleaf). NHS R&D HTA Programme T he overall aim of the NHS R&D Health Technology Assessment (HTA) Programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Population Screening Panel and funded as project number 95/40/01. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work either prioritised by the Standing Group on Health Technology, or otherwise commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.

show abstract

The identification of false negatives in a population of interval cancers: a method for audit of screening mammography

Cited by 23 publications

References 12 publications

Geographical distribution of breast cancers on the mammogram: an interval cancer database

Geographical distribution of breast cancers on the mammogram: an interval cancer database

Invasive interval cancers in the ÖstergÖtland Mammographic Screening Programme: radiological analysis

False-negative results in screening programmes: systematic review of impact and implications.

Contact Info

Product

Resources

About