Interhospital variations in diagnostic work-up following recall at biennial screening mammography—a population-based study

Objectives

Quality control in breast cancer screening programmes has been subject of several studies. However, less is known about the clinical diagnostic work-up in recalled women with a suspicious finding at screening mammography. The current study focuses on interhospital differences in diagnostic work-up strategies.

Materials and methods

In this retrospective analysis, using a prospectively obtained database, we included 17,809 women who participated in the Dutch national screening programme between 2009 and 2019 and were recalled to a hospital for analysis of a suspicious mammographic abnormality. The diagnostic work-up (e.g., type and frequency of additional imaging and biopsy) in the different hospitals were compared and analysed by multivariable analysis to correct for confounders.

Results

Use of biopsy varied from 36.7% to 48.7% (p < 0.001) between hospitals, and the use of problem-solving magnetic resonance imaging (MRI) from 2.1% to 6.9% (p < 0.001). These interhospital differences remained after correction for patients and tumour characteristics. The percentage of women with a delayed breast cancer diagnosis, defined as histopathological confirmation of breast cancer more than three months after recall or first analysis in the hospital, varied from 2.7% to 6.1% between hospitals (p = 0.07).

Conclusions

In our screening region interhospital differences were observed in diagnostic work-up following recall at biennial screening mammography. Though statistically significant, absolute differences were small, and therefore, their clinical impact appears to be limited.

Key Points

Question It is unclear how diagnostic work-up strategies vary between hospitals for women recalled after suspicious findings in breast cancer screening.

Findings Significant differences in biopsy techniques and the use of problem-solving MRI were observed, though the clinical impact of these variations is likely to be marginal.

Clinical relevance Evaluation of interhospital variation in the diagnostic work-up strategies after recall may aid in optimising the quality of breast cancer care and, indirectly, the effectiveness of the screening programme.