Breast cancer detected and missed by screen-film and digital screening mammography: Studies on trends in classification and surgical treatment in the south of the Netherlands since 1997

Abstract

o The specific aims of this thesis are to describe the trends in the diagnosis of advanced breast cancer, the trends in the use of biopsies and surgical management and to explore the effects of the introduction of digital mammography in breast cancer screening. The majority of the advanced breast cancers detected at biennial screening cannot be prevented. In order to obtain a modest reduction of the risk of detecting breast cancer in an advanced stage, efforts are needed to minimize the number of women with an extended screening interval. Quality control in hospitals treating breast cancer patients is important in order to ensure optimal care for women diagnosed with breast cancer. Surgeons performing breast conserving surgery should try to pre-operatively identify patients with a high risk of positive resection margins, especially focusing on the role of microcalcifications since these are more commonly encountered in a screened population. Furthermore, continuous efforts should be made to improve the quality of the excision of non-palpable tumours. In the South of the Netherlands, digital mammography significantly increased the referral rate and cancer detection rate, at the expense of a lower positive predictive value of referral and biopsy. Digital mammography results in a significantly higher cancer detection rate, but programme sensitivity was similar for both screen-film and digital mammography screening.