Early experience in breast cancer screening: emphasis on development of protocols for triple assessment

• Published in: Breast (Edinburgh) Vol. 2; no. 3; pp. 148 - 153
• Main Authors: Ellis, I.O., Galea, M.H., Locker, A., Roebuck, E.J., Elston, C.W., Blamey, R.W., Wilson, A.R.M.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 1993
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/0960-9776(93)90058-N

The early experience of the Nottingham Breast Screening Service participating in the prevalent round of the UK National Health Service Breast Screening Programme is presented. Over a 3-year-period management protocols have been developed and refined. These protocols are based on the principle of multidisciplinary triple assessment, including imaging, clinical evaluation and fine needle aspiration cytology (FNAC). Throughout this period screening performance indicators well within the national guidelines were achieved. In addition, recall for assessment rates fell from 12% to 3.4%, the benign-to-malignant biopsy ratio falling from 1:1 to 0.3:1, while the cancer detection rate of 7 per 1000 women screened was maintained. A progressive increase in diagnostic specificity was achieved while retaining cancer detection sensitivity. Overall, 60% of carcinomas were diagnosed by FNAC. Using the Nottingham Prognostic Index, 47% of cancers were in the good prognostic group, previously shown to correlate with a 10 year survival of 83%. These results are encouraging and suggest that a significant mortality benefit can be predicted for screen detected breast cancers. The adoption of a multidisciplinary triple assessment increases the specificity of the screening test without compromising sensitivity.