Audit of high prevalent breast screening recall rates: Torbay Hospital

Introduction

The target percentage of women recalled after prevalent round breast screening is <7 % with minimum standards <10 %. Torbay Hospital's prevalent round recall is high at 11.4 %. We plan to assess patterns of recall by category to see if any particular reason for recall could be decreased.

Methods

Retrospective audit of 12 months of prevalent round recalls March 2013-February 2014. All age groups were included. Each recall was grouped into one/more of the following categories: calcification, well-defined mass, ill-defined mass, asymmetric density, distortion, clinical, other. We will calculate the proportion of recalls per group that proved to be malignancy and assess to see if any category was a poor predictor of malignancy. All histology proven malignancies from 2012/13 and 2014/15 will also be categorised by group.

Results

There were 215 recalls for ages 49–69, 15 proven malignancies. 77% of Ill-defined mass, 22% of distortion and 10% of calcifications recalled proved to be malignant and are the strongest predictors of malignancy. Well-defined mass and asymmetric density had 0 % malignancy rates and accounted for 129 (59.4 %) of prevalent recalls. Thirteen clinical recalls (1.4 %) were also 0 % for malignancy but beyond the control of the screening service. Further audit was performed looking at the proven malignancies from 2012/13 and 2014/15, which showed a total of 33 malignancies with 13 calcifications, 17 ill-defined masses, one asymmetry, one distortion and one clinical recall.

Conclusion

A high proportion of recalls (60 %) are for well-defined mass and asymmetric density which have poor predictive outcome. These groups are potential areas to decrease recall rates. A total 1.4 % of clinical recalls are beyond the control of the screening service, which would bring prevalent recalls to a compliant level of 10 %.