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Failure to appropriately screen womenaccording to international guidelines–
what are the consequences?
Alison Johnston*, M Sugrue , S Curran
Department of Breast Surgery, Letterkenny General Hospital and Donegal Clinical and Research Academy
Breast Cancer outcomes- Early Dx Optimal
1
2
3
4
Stage
Tailored personal care
50-65
Family history risk
Family history: assess risk level
17-29%<17% ≥30%
Low Moderate High
1<40 (Primary)
2 < 60 ( one Primary)
3 any age
Moderate risk:• Yearly from 40-
50yrs
High risk:• Imaging from
>30yrs• 1% genetic
counselling
Aim
Assess appropriateness of breast screening in
patients newly diagnosed with breast cancer.
Results – Patient Profile
200 female patients
mean age 61 ± 15.4 (range 28-99)
Previous mammogram 82/200 (41%)
Results•
•
•
• 143 57
Appropriately Inappropriately
screened screened
200 patients
Stage at diagnosis n=200
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4
Appropriately sc reened
Inappropriately sc reened
%
stage
Tumour size (mm)n=200
mm
20
24
28
32
36
40
appropriately
screened
inappropriately
screened
appropriatelyscreenedinappropriatelyscreened
Yates' p-value 0.001
Results200 patients
112 88
no criteria
Appropriate 31 Failed
57
met screening criteria
Results Meeting screening criteria
patients
41 5 16
BC criteria BC criteria & FH FH
57
met Breast Check criteria
Declined offerOffer-Post diagnosis
No offer
46
25 15 6
Nodal status- meeting screening criteria n=88
%
P-value 0.02
Negative Positive0
10
20
30
40
50
60
70
80
90
100 Appropriate
Inappropriate
Stage at presentationmeeting screening criteria n=88
Early Later0
102030405060708090
100 Appropriate
Inappropriate
Stage
%
p-value 0.006(0-2) (3&4)
Conclusion
• Failure to risk assess and screen >25% of all breast cancer presentations
• Those with high risk/screening criteria failure in 65%
• Failure to screen More advanced cancer
• Donegal will continue to have poorer outcome if delayed presentations continue
Johnston, A. Curran, S. and Sugrue, M. (2015) Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis. Advances in Breast Cancer Research, 4, 53-62. doi: 10.4236/abcr.2015.42006.
Outcomes:
Contacted key stakeholders:
• NCCP
• Breast Check
• GPs in county
• Women’s Groups
• Local radio and press
• Follow on study