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Setz-Pels W.,Catharina Hospital | Duijm L.E.M.,Weg door Jonkerbos 100 | Coebergh J.W.,Erasmus Medical Center | Rutten M.,Robert Bosch GmbH | And 3 more authors.
British Journal of Cancer | Year: 2013

Background:In the current study, mammography adherence of women who had experienced a false-positive referral is evaluated, with emphasis on the probability of receiving surveillance mammography outside the national screening programme.Methods:We included 424 703 consecutive screens and collected imaging, biopsy and surgery reports of 3463 women who experienced a false-positive referral. Adherence to screening, both in and outside the screening programme, was evaluated.Results:Two years after the false-positive referral, overall screening adherence was 94.6%, with 64.7% of women returning to the national screening programme, compared with 94.9% of women re-attending the screening programme after a negative screen (P<0.0001). Four years after the false-positive screen, the overall adherence had decreased to 85.2% (P<0.0001) with a similar proportion of the women re-attending the screening programme (64.4%) and a lower proportion (20.8%) having clinical surveillance mammography. Women who had experienced a false-positive screen at their first screening round were less likely to adhere to mammography than women with an abnormal finding at one of the following screening rounds (92.4% vs 95.5%, P<0.0001).Conclusion:Overall screening adherence after previous false-positive referral was comparable to the re-attendance rate of women with a negative screen at 2-year follow-up. Overall adherence decreased 4 years after previous false-positive referral from 94.6% to 85.2%, with a relatively high estimate of women who continue with clinical surveillance mammography (20.8%). Women with false-positive screens should be made aware of the importance to re-attend future screening rounds, as a way to improve the effectiveness of the screening programme. © 2013 Cancer Research UK. All rights reserved. Source


Klompenhouwer E.G.,Catharina Hospital | Duijm L.E.M.,Canisius Wilhelmina Hospital | Voogd A.C.,Comprehensive Cancer Center South Eindhoven Cancer Registry | Voogd A.C.,Maastricht University | And 6 more authors.
European Radiology | Year: 2014

Objectives: Substantial inter-observer variability in screening mammography interpretation has been reported at single reading. However, screening results of pairs of screening radiologists have not yet been published. We determined variations in screening performances among pairs of screening radiologists at non-blinded double reading. Methods: We included pairs of screening radiologists with at least 7,500 screening examinations per pair, obtained between 1997 and 2011. During 2-year follow-up, breast imaging reports, surgical reports and pathology results were collected of all referred women and interval cancers. Referral rate, cancer detection rate, positive predictive value and sensitivity were calculated for each pair. Results: A total of 310,906 screening mammograms, read by 26 pairs of screening radiologists, were included for analysis. The referral rate ranged from 1.0 % (95 % CI 0.8 %-1.2 %) to 1.5 % (95 % CI 1.3 %-1.8 %), the cancer detection rate from 4.0 (95 % CI 2.8-5.2) to 6.3 (95 % CI 4.5-8.0) per 1,000 screens. The programme sensitivity and positive predictive value of referral ranged from 55.1 % (95 % CI 45.1 %-65.1 %) to 81.5 % (95 % CI 73.4 %-89.6 %) and from 28.7 % (95 % CI 20.8 %-36.6 %) to 49.5 % (95 % CI 39.7 %-59.3 %), respectively. Conclusion: We found significant variations in screening outcomes among pairs of screening radiologists at non-blinded double reading. This stresses the importance of monitoring screening results on a local scale. Key Points: • Substantial inter-observer variability in screening mammography interpretation is known at single reading • Population-based study showed significant variations in outcomes among pairs of screening radiologists • Local monitoring and regular feedback are important to optimise screening outcome. © 2014 European Society of Radiology. Source


Klompenhouwer E.G.,Catharina Hospital | Voogd A.C.,Comprehensive Cancer Center South Eindhoven Cancer Registry | Voogd A.C.,Maastricht University | Den Heeten G.J.,National Expert and Training Center for Breast Cancer Screening | And 6 more authors.
European Journal of Cancer | Year: 2015

Purpose To prospectively determine the screening mammography outcome at blinded and non-blinded double reading in a biennial population based screening programme in the south of the Netherlands. Methods We included a consecutive series of 87,487 digital screening mammograms, obtained between July 2009 and July 2011. Screening mammograms were double read in either a blinded (2nd reader was not informed about the 1st reader's decision) or non-blinded fashion (2nd reader was informed about the 1st reader's decision). This reading strategy was alternated on a monthly basis. Women with discrepant readings between the two radiologists were always referred for further analysis. During 2 years follow-up, we collected the radiology reports, surgical correspondence and pathology reports of all referred women and interval breast cancers. Results Respectively 44,491 and 42,996 screens had been read either in a blinded or non-blinded fashion. Referral rate (3.3% versus 2.8%, p < 0.001) and false positive rate (2.6% versus 2.2%, p = 0.002) were significantly higher at blinded double reading whereas the cancer detection rate per 1000 screens (7.4 versus 6.5, p = 0.14) and positive predictive value of referral (22% versus 23%, p = 0.51) were comparable. Blinded double reading resulted in a significantly higher programme sensitivity (83% versus 76%, p = 0.01). Per 1000 screened women, blinded double reading would yield 0.9 more screen detected cancers and 0.6 less interval cancers than non-blinded double reading, at the expense of 4.4 more recalls. Conclusion We advocate the use of blinded double reading in order to achieve a better programme sensitivity, at the expense of an increased referral rate and false positive referral rate. © 2014 Elsevier Ltd. All rights reserved. Source


Setz-Pels W.,Catharina Hospital | Duijm L.E.M.,Catharina Hospital | Louwman M.W.J.,Comprehensive Cancer Center South Eindhoven Cancer Registry | Roumen R.M.H.,Maxima Medical Center | And 3 more authors.
European Radiology | Year: 2012

Objectives: To determine the characteristics and screening outcome of women referred twice at screening mammography. Methods: We included 424,703 consecutive screening mammograms and collected imaging, biopsy and surgery reports of women with screen-detected breast cancer. Review of screening mammograms was performed to determine whether or not an initial and second referral comprised the same lesion. Results: The overall positive predictive value of referral for cancer was 38.6% (95% CI 37.3-39.8%). Of 147 (2.6%) women referred twice, 86 had been referred for a different lesion at second referral and 32 of these proved malignant (37.2%, 95% CI 27.0-47.4%). Sixty-one women had been referred twice for the same lesion, of which 22 proved malignant (36.1%, 95% CI 24.1-48.0%). Characteristics of these women were comparable to women with cancer diagnosed after first referral. Compared with women without cancer at second referral for the same lesion, women with cancer more frequently showed suspicious densities at screening mammography (86.4% vs 53.8%, P=0.02) and work-up at first referral had less frequently included biopsy (22.7% vs 61.5%, P=0.004). Conclusions: Cancer risk in women referred twice for the same lesion is similar to that observed in women referred once, or referred for a second time but for a different lesion. Key Points: • Cancer risk was 36% for lesions referred twice at screening mammography • The cancer risk was similar for lesions referred only once at screening • Densities at first referral were associated with increased cancer risk at second referral • No biopsy at first referral was associated with increased cancer risk at second referral • Patient and tumour characteristics were similar for women with and without diagnostic delay. © European Society of Radiology 2012. Source


Setz-Pels W.,Catharina Hospital | Duijm L.E.M.,Catharina Hospital | Groenewoud J.H.,Rotterdam University | Voogd A.C.,Comprehensive Cancer Center South Eindhoven Cancer Registry | And 4 more authors.
Radiology | Year: 2011

Purpose: To determine the incidence of bilateral breast cancer at biennial screening mammography and to assess the sensitivity of screening in the detection of bilateral breast cancer. Materials and Methods: All women gave written informed consent, and the requirement to obtain review board approval was waived. The authors included all 302 196 screening mammograms obtained in 80 466 women aged 50-75 years in a southern breast screening region of the Netherlands between May 1998 and July 2008. During 2-year follow-up, the authors collected clinical data, breast imaging reports, biopsy results, and breast surgery reports from all patients with screening-detected and interval cancers. Two screening radiologists reviewed the screening and clinical mammograms of all bilateral screening-detected and interval cancers for mammographic abnormalities. The radiologists were initially blinded to each other's referral opinion, and discrepant assessments were followed by consensus reading. Results: Of all women with screening-detected cancer (n = 1555) or interval cancer (n = 585), 52 (2.4%) had bilateral breast cancer. The sensitivity of screening mammography in the detection of bilateral breast cancer was 19 %(10 of 52 women;95% confidence interval:8.5%, 29.9%). At blinded review, 18 of the 53 tumors not detected at screening (34%) were considered to be missed, 11 (21%) showed nonspecific minimal signs, and 24 (45%) had been mammographically occult at screening. Five women referred for further analysis experienced a 6-17-month delay in the diagnosis of the second breast cancer;in four of those women, the delay resulted from an incorrect Breast Imaging Reporting and Data System classification at clinical mammography. Conclusion: The sensitivity of screening mammography in the detection of bilateral breast cancer is disappointingly low. Both screening radiologists and clinical radiologists should pay vigorous attention to the contralateral breast to detect bilateral malignancies without diagnostic delay. © RSNA, 2011. Source

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