Audit of negative assessments in a breast-screening programme in women who later develop breast cancer—implications for survival

SummaryThe aim of this study was to examine observed short-term survival, to estimate future survival, and to assess the impact on survival of amending procedures to avoid false negatives in women recalled for further assessment due to a suspicious screening mammogram. From the start of screening in the seven centres in the East Anglian region, 1 April 1989 to 31 December 1999, 503 493 women from a total population of 2.2 million were screened, 25 346 were recalled for an assessment and 3689 were diagnosed with breast cancer. Of the 21 657 women given a negative result at these assessments, 193 women were subsequently diagnosed with 194 breast tumours at the site previously assessed. These women were followed up for survival, with survival analysis adjusting for host and tumour attributes. We also predicted long-term survival using the pathological features of the tumours diagnosed. From previous estimates of tumour progression rates, we estimated the reduction in incidence of advanced tumours and the potential saving of lives had unsatisfactory assessments been carried out within guidelines. There were 17 deaths, 15 in women who had unsatisfactory assessments. Five-year survival was estimated at 93% (95% CI: 88–97%) for breast cancer and 91% (95% CI: 86–95%) for all cause deaths. Women with positive nodes and/or larger tumours had significantly worse survival. Twenty years survival for women with unsatisfactory assessments was estimated at 66% (35 deaths) and predicted a potential saving of 7–9 lives (14–18% reduction in expected fatality within this special tumour population) had original assessments been carried out within current guidelines. This retrospective audit of a small and special tumour population shows a potential reduction in breast cancer deaths of 18%, had current guidelines been available for the original assessments. Increased use of percutaneous biopsy in recent years should address the problem.