Subsequent mammography reduces recall and increases breast cancer detection: an audit of a screening program.

Abstract

Objective: To analyze recall rates in a public breast cancer screening facility in Campinas, Brazil.

Methods: A prospective assessment of outcomes on screening mammographies (MMG) between July 2023 and August 2024. BI-RADS® 0,4/5 indicated positive results, and women recalled. The variables were age, whether first or subsequent MMG, and biopsy (cancer positive or negative). The outcomes were recall rate and cancer detection rate on the recall (CDR). Prevalence ratio with 95% confidence interval (PR) estimated the risk.

Results: There were included 19,377 MMG on women over 40: 15,983 subsequent MMG (82.5%), and 1,646 women recalled (BR 0,4/5). Adherence to recall was over 99%. The recall rates were 12.4% at first and 7.7% at subsequent MMG. Recall rate was 1.6 times higher at first than at subsequent MMG (PR 1.61;1.45-1.79). CDR was higher at subsequent MMG. A first MMG reduced the risk of cancer detection by 71% (PR 0.29-0.15;0.58). Compared to women 50-69, there were no differences in the risks of recall and cancer detection at first MMG. At subsequent MMG the recall risk was higher in women 40-49 (PR 1.16;1.03-1.30), and over 69 (PR 1.47;1.03-2.12). The risk of cancer detection was 60% lower in women 40-49 (PR 0.60;0.36-0.99), and 2.7 times higher in women over 69 (PR 2.78;1.32-5.84).

Conclusion: The recall rates were 12.4% at first and 7.7% at subsequent MMG. Adherence was high. Screening efficiency was higher in women 50-69. At subsequent screenings women 40-49 showed a higher recall rate and a lower CDR when compared to women 50-69.