Failure to appropriately screen womenaccording to international guidelines–

what are the consequences?

Alison Johnston*, M Sugrue , S Curran

Department of Breast Surgery, Letterkenny General Hospital and Donegal Clinical and Research Academy

Breast Cancer outcomes- Early Dx Optimal

1

2

3

4

Stage

Tailored personal care

50-65

Family history risk

Family history: assess risk level

17-29%<17% ≥30%

Low Moderate High

1<40 (Primary)

2 < 60 ( one Primary)

3 any age

Moderate risk:• Yearly from 40-

50yrs

High risk:• Imaging from

>30yrs• 1% genetic

counselling

Aim

Assess appropriateness of breast screening in

patients newly diagnosed with breast cancer.

Results – Patient Profile

200 female patients

mean age 61 ± 15.4 (range 28-99)

Previous mammogram 82/200 (41%)

Results•

•

•

• 143 57

Appropriately Inappropriately

screened screened

200 patients

Stage at diagnosis n=200

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4

Appropriately sc reened

Inappropriately sc reened

%

stage

Tumour size (mm)n=200

mm

20

24

28

32

36

40

appropriately

screened

inappropriately

screened

appropriatelyscreenedinappropriatelyscreened

Yates' p-value 0.001

Results200 patients

112 88

no criteria

Appropriate 31 Failed

57

met screening criteria

Results Meeting screening criteria

patients

41 5 16

BC criteria BC criteria & FH FH

57

met Breast Check criteria

Declined offerOffer-Post diagnosis

No offer

46

25 15 6

Nodal status- meeting screening criteria n=88

%

P-value 0.02

Negative Positive0

10

20

30

40

50

60

70

80

90

100 Appropriate

Inappropriate

Stage at presentationmeeting screening criteria n=88

Early Later0

102030405060708090

100 Appropriate

Inappropriate

Stage

%

p-value 0.006(0-2) (3&4)

Conclusion

• Failure to risk assess and screen >25% of all breast cancer presentations

• Those with high risk/screening criteria failure in 65%

• Failure to screen More advanced cancer

• Donegal will continue to have poorer outcome if delayed presentations continue

Johnston, A. Curran, S. and Sugrue, M. (2015) Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis. Advances in Breast Cancer Research, 4, 53-62. doi: 10.4236/abcr.2015.42006.

Outcomes:

Contacted key stakeholders:

• NCCP

• Breast Check

• GPs in county

• Women’s Groups

• Local radio and press

• Follow on study