Benign solitary breast masses in the prevalent screening round: do they contribute to a high recall rate?

Background

The Breast Test Wales prevalent round recall rate between 2003 and 2006 was 9.07% (above the NHSBSP target of 7%) and remains high. This study was based on the hypothesis that recall of benign solitary masses might be a major contributor to this as no prior imaging is available.

Methods

Prospectively collected data from Breast Test Wales (South East Wales) identified all prevalent screens in a 3-year cycle recalled for a benign mass lesion confirmed by core biopsy. All women attended a subsequent screen and remained free of cancer. Mammograms were retrospectively reviewed and the lesions were re-evaluated by applying criteria typical of a benign mass.

Results

A total of 2,322 women following a prevalent screen were recalled; 2,069 were returned to routine recall without biopsy (cysts are included in this group), 186 were diagnosed with cancer and 105 had a benign biopsy where mammography had been considered benign or probably benign. The benign to malignant biopsy ratio was 1:1.8. A total 46.6% (n = 49) lesions on retrospective review of mammography showed typical benign characteristics. Dense breast composition and overlying glandular tissue were noted to correlate with higher rates of retrospectively indicated recall.

Conclusions

Stricter adherence to applying classification of benign solitary lesions could reduce the recall rate and decrease the psychological distress for these women without adversely compromising the cancer detection rate. The impact on the overall recall rate would be small but would significantly improve the benign to malignant biopsy ratio. The issue of breast density and overlying tissue may be resolved with the advent of digital applications such as tomosynthesis.