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Breast cancers missed by the arbitration process


In our institution double reading of screening mammo-grams with arbitration by consensus was introduced in January 2000. Discordant double reading opinions are discussed at a weekly arbitration meeting that all screen readers attend and a decision is made as to whether the patient should be recalled to assessment or returned to routine screening. To date, there is little known about the outcome of arbitrated cases that are returned to routine screening. We aim to identify the number of breast cancer cases that subsequently developed at the arbitrated site that were returned to routine screening at the arbitration meeting and to determine the mammographic and pathological features of these cancers.


From KC-62 records all screen-detected and interval cancer patients were identified between January 2001 and March 2006. From this, we identified all cases that had undergone arbitration but were not recalled at the screen prior to the cancers being diagnosed. Mammograms and histology were reviewed.


Eight patients subsequently developed cancer at the previously arbitrated site. Six were detected at the next screening round and two presented as interval cases; within 1 year, three out of eight of these cases were better demonstrated on the cranio-caudal view. Six out of the eight cases were mammographically subtle densities that developed into masses, one was architectural distortion and two were microcalcification. All cases but one had a good Nottingham Prognostic Index.


Cancers that developed following non-recall of arbitrated cases were mostly subtle masses, better demonstrated on cranio-caudal view and mainly low grade tumours.

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Lee, C., McLean, L. & O'Brien, A. Breast cancers missed by the arbitration process. Breast Cancer Res 11 (Suppl 2), P5 (2009).

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  • Breast Cancer
  • Grade Tumour
  • Pathological Feature
  • Breast Cancer Case
  • Routine Screening