Interval breast cancers: positive influencing behaviour

Introduction

Studies estimate that 10 to 32% of breast cancers are over-looked in mammograms. One of the important causes of interval breast cancer is fatigue and loss of concentration. The likelihood of fatigue increases with the duration of a reporting session and errors are more likely to occur towards the end of the session. The purpose of this talk is to address the lack of awareness of the issues that drive reporting performance.

Methods

A retrospective study was carried out on interval breast cancers from a 2-year period. This identified 90 histopathologically proven interval breast cancers. Each interval cancer mammogram was reviewed by two blinded consultant radiologists and placed into one of three categories on retrospective radiological review: Category 1: normal; Category 2: uncertain; Category 3: suspicious. Each case was then analysed further to correlate the interval categories with their position on the mammography roller viewer.

Results

Of the 90 interval breast cancers, 59 (66%) were Category 1, 14 (16%) were Category 2 and 17 (18%) were Category 3. Statistical analyses with one-way ANOVA test revealed the presence of clinical significance between Category 3 cases and their position in the roller viewer (P <0.021).

Conclusions

Fatigue is identified as an important factor responsible for missing breast cancer. Aside from making changes in double-reporting techniques, human performance factors such as nutrition, rest, behaviour prior to reporting and environment have to be considered. A national programme has to be implemented to facilitate a plan to raise awareness of these factors in the NHS culture.