In the NHS breast screening programme does radiographer-reported clinical history add value to mammography?

Introduction

Currently, all women attending breast screening are asked by radiographers about breast symptoms. Recording and assessing these responses takes time. We have studied the usefulness of this practice. No group that we are aware of have validated this since the routine use of two-view mammography.

Methods

In our region, 40,204 women were screened over a 22-month period. All responses from the 703 (1.7%) women reporting breast symptoms were analysed and films reviewed from all cancers detected in this group.

Results

The commonest complaints were pain 386 (55%) or a lump 163 (23%). Less frequent symptoms included skin and nipple changes. Of the symptomatic women, 157 (22%) were recalled for assessment. More women complaining of a lump were recalled (58%) than those reporting skin changes (39%) or pain (7%).

From those recalled, 23 cancers were diagnosed, of which 14 were in women reporting a lump. Out of the 23 cancers, 21 had M4/M5 mammographic abnormalities (91%). Two women with cancer had normal screening mammograms but were recalled due to their clinical history. The first patient reported a lump. The second clinical recall was due to an asymptomatic skin dimple noticed by the radiographer. Both clinical abnormalities corresponded to invasive breast cancers.

Conclusion

Of the 40,204 women screened, 2 (<0.0001%) had cancer diagnosed following a clinical history recall with normal screening mammograms. This is a low yield and questions how useful the clinical history is, given the extra time and resources required for assessment.