We identified relevant published work with a MEDLINE search, using the following strategy: we exploded the MeSH term “breast neoplasms” (from 1966 to April, 2005) and searched the term “interval cancer”. Abstracts were read by one author (NH) and full papers were reviewed if they provided information on any aspect of radiological review of interval breast cancers. Additional papers were identified through the reference list of relevant papers and by discussion with content experts.
ReviewRadiological surveillance of interval breast cancers in screening programmes
Introduction
Population screening for breast cancer is widely undertaken in health-care systems of industrialised countries, and most organised breast screening programmes (figure 1) monitor the occurrence of interval cancers—ie, those diagnosed after a negative mammographic screen and before the next scheduled screen. However, radiological surveillance (continuing mammographic review and classification) of interval breast cancers is not routine practice in most breast screening programmes, outside of evaluation studies. Here, we define radiological surveillance of interval breast cancers and identify methodological difficulties in the radiological review process and in categorisation of intervals as false-negative, true, or occult. Furthermore, we outline how information from radiological surveillance can guide potential screening methods and research aimed at control of interval breast cancers in screening.
Section snippets
Epidemiological surveillance
Early detection by mammographic screening reduces breast cancer mortality in randomised trials.1 The benefit from breast screening is largely dependent on the quality of the screening programme, and a low rate of interval cancers is an important indicator of the success of cancer screening in practice.2, 3, 4 Cancer screening programmes thus monitor the incidence of interval cancers as an indicator of screening effectiveness. This observation forms part of epidemiological surveillance, with
Definition of interval cancers and radiological surveillance
An interval breast cancer is diagnosed after a (negative) mammographic screen and before the next scheduled screen—ie, in the interscreening interval. This definition includes cancers not identified at the time of screening (most interval cancers) and those recalled because of a positive screen but (incorrectly) dismissed after assessment; this group of recalled cancers forms a small proportion of all interval cancers.4 The definition does not include cancers detected at routine screening that
False-negative interval cancers
These cancers are present on the screening mammogram but are not recognised by the radiologist (or film reader) at the time of screening. They might be perception errors, in which the abnormality is present on the film but is not seen by the film reader, or interpretation errors, in which the abnormality is seen by the film reader but is interpreted as not being malignant disease. False-negative interval cancers can be further classified into two types: abnormalities that are regarded as
Conclusion
Radiological review of interval breast cancers as part of quality improvement in screening is not universally used in organised breast screening programmes, or it can be restricted to evaluation studies or isolated case-review. Radiological surveillance of interval breast cancers is a broader and more continuous process than radiological review, and it has the potential to guide public-health decisions about changes to screening programmes. Radiological surveillance means that valid,
Search strategy and selection criteria
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Cited by (64)
Breast cancer missed at screening; hindsight or mistakes?
2023, European Journal of RadiologyAI-based prevention of interval cancers in a national mammography screening program
2022, European Journal of RadiologyCitation Excerpt :Some of these cancers are retrospectively visible on the prior screening images. Approximately 20–25% of interval cancers are classified as minimal signs, and a further 20–25% are considered missed as false negatives [1–5]. The European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis (EUREF) have objective criteria for defining minimal signs and false negative interval cancers [1].
Retrospective radiological review and classification of interval breast cancers within population-based breast screening programmes for the purposes of open disclosure: A systematic review
2021, European Journal of RadiologyCitation Excerpt :This current study observed an absence of consensus in methodology in published studies for the recommended radiological review and classification of interval cancers. This observation is a consistent finding and has been acknowledged previously [4]. Consideration must be given to the many factors that form part of the routine screening environment that can influence the detection of interval cancers, all of which can influence reviews, interpretation of radiological review findings and subsequent classification.
Preoperative breast imaging review: Interests and limits of specialized validation in oncology
2020, Bulletin du Cancer