Incidental breast cancer on CT: factors associated with detection and relationship to prognostics and treatment options.

Abstract

Objectives: With the increasing use of CT, it may help detecting incidental breast cancers. Our study analysed the relationship between breast cancer detection on CT and features of the cancer, factors related to the scan and report, the treatment offered, and cancer prognostics, in NHS settings.

Methodology and results: Out of the retrospectively included 56 scans in 42 patients, 38 reports (67.9%) missed the breast cancers. Missed cancers were found to be smaller (P = 0.0042), progressed more by the time they were diagnosed (P = 0.0011), and their initial treatment was delayed by a median of 3.4 years (P < 0.0001). Cancers were more likely to be missed out of hours (P = 0.0485), in an outpatient reporting session (P = 0.0397), when the cancer presented as a circumscribed mass (P = 0.0196), and when the breasts were dense (P = 0.0250).

Conclusion: A significant percentage of breast cancer is missed on CT, with subsequent delay in starting treatment. Systematic approach when reporting, awareness of atypical cancer presentations, and minimising distractions while reporting, may improve the detection of breast cancer on CT.

Advances in knowledge: This study identified opportunities to detect, and the factors associated with missing and delayed treatment of, incidental breast cancer on CT, specifically in NHS settings. By increasing radiologists' awareness of those factors, it is hoped to prevent delay in treatment of this cohort of cancer patients.