Journal of breast imaging · 2026
The Impact of a Robust Supplemental Screening Program on False-Negative Rates: Time for New Benchmarks?
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Huppe Ashley, Winblad Onalisa, Peterson Jessica, Smith Camron, Hill Molly, Clark Lauren, Walter Carissa, Aripoli Allison
Аннотация
OBJECTIVE: Screening mammography false-negative rates (FNRs) measure interval cancers (ICs) that are confounded by asymptomatic false-negative (FN) cancers detected on supplemental screening (SS) examinations. The purpose of this study was to 1) evaluate the impact of SS on FNRs for patients at higher-than-average risk in a robust SS program and 2) compare patient and tumor characteristics of symptomatic ICs and asymptomatic FN cancers.
METHODS: Screening mammogram audit metrics from an academic institution from July 1, 2018, to June 30, 2023, were retrospectively reviewed. A negative screening mammogram with a subsequent diagnosis of cancer within 12 months was considered an FN cancer. Patient risk, method of detection, SS utilization, and tumor characteristics were collected. Cochran-Mantel-Haenszel tests were used to analyze trends, and univariable tests were used to compare symptomatic and asymptomatic cases.
RESULTS: Of 106 750 screening mammograms, 624 screening-detected cancers and 119 FN cancers were identified, with a cancer detection rate of 5.8/1000 and an FNR of 1.11/1000. There were 53 (45%) symptomatic ICs and 66 (55%) asymptomatic FNs, with a symptomatic FNR of 0.50/1000. Patients with symptomatic IC were more likely to have a personal history of breast cancer (P = .0289), and 74% (39/53) were higher-than-average risk. Symptomatic ICs were larger at diagnosis (mean size 2.3 cm vs 1.5 cm; P = .0293). MRI detected the majority (37/66, 60%) of asymptomatic FNs.
CONCLUSION: A robust SS program allows for the symptomatic FNR to fall below published national performance benchmarks from the Breast Cancer Surveillance Consortium. Most patients with symptomatic IC were at higher-than-average risk and underutilized SS MRI.
METHODS: Screening mammogram audit metrics from an academic institution from July 1, 2018, to June 30, 2023, were retrospectively reviewed. A negative screening mammogram with a subsequent diagnosis of cancer within 12 months was considered an FN cancer. Patient risk, method of detection, SS utilization, and tumor characteristics were collected. Cochran-Mantel-Haenszel tests were used to analyze trends, and univariable tests were used to compare symptomatic and asymptomatic cases.
RESULTS: Of 106 750 screening mammograms, 624 screening-detected cancers and 119 FN cancers were identified, with a cancer detection rate of 5.8/1000 and an FNR of 1.11/1000. There were 53 (45%) symptomatic ICs and 66 (55%) asymptomatic FNs, with a symptomatic FNR of 0.50/1000. Patients with symptomatic IC were more likely to have a personal history of breast cancer (P = .0289), and 74% (39/53) were higher-than-average risk. Symptomatic ICs were larger at diagnosis (mean size 2.3 cm vs 1.5 cm; P = .0293). MRI detected the majority (37/66, 60%) of asymptomatic FNs.
CONCLUSION: A robust SS program allows for the symptomatic FNR to fall below published national performance benchmarks from the Breast Cancer Surveillance Consortium. Most patients with symptomatic IC were at higher-than-average risk and underutilized SS MRI.