One-stop diagnostic breast clinics: how often are breast cancers missed?

The aim of this study was to estimate the number of patients discharged from a symptomatic breast clinic who subsequently develop breast cancer and to determine how many of these cancers had been ‘missed’ at initial assessment. Over a 3-year period, 7004 patients were discharged with a nonmalignant...

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Bibliographic Details
Published in:British journal of cancer 2009-06, Vol.100 (12), p.1873-1878
Main Authors: Britton, P, Duffy, S W, Sinnatamby, R, Wallis, M G, Barter, S, Gaskarth, M, O'Neill, A, Caldas, C, Brenton, J D, Forouhi, P, Wishart, G C
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Ambulatory Care Facilities
Biological and medical sciences
Biomedical and Life Sciences
Biomedicine
Biopsy
Breast cancer
Breast Neoplasms - diagnosis
Cancer Research
Clinical Study
Clinics
Diagnosis, Differential
Diagnostic Errors
Drug Resistance
Epidemiology
Female
Follow-Up Studies
Gynecology. Andrology. Obstetrics
Humans
Information systems
Mammary gland diseases
Mammography
Medical research
Medical sciences
Middle Aged
Molecular Medicine
Oncology
Patients
Performance management
Prospective Studies
Quality control
Reproducibility of Results
Sensitivity and Specificity
Time Factors
Tumors
Womens health
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Summary:The aim of this study was to estimate the number of patients discharged from a symptomatic breast clinic who subsequently develop breast cancer and to determine how many of these cancers had been ‘missed’ at initial assessment. Over a 3-year period, 7004 patients were discharged with a nonmalignant diagnosis. Twenty-nine patients were subsequently diagnosed with breast cancer over the next 36 months. This equates to a symptomatic ‘interval’ cancer rate of 4.1 per 1000 women in the 36 months after initial assessment (0.9 per 1000 women within 12 months, 2.6 per 1000 women within 24 months). The lowest sensitivity of initial assessment was seen in patients of 40–49 years of age, and these patients present the greatest imaging and diagnostic challenge. Following multidisciplinary review, a consensus was reached on whether a cancer had been missed or not. No delay occurred in 10 patients (35%) and probably no delay in 7 patients (24%). Possible delay occurred in three patients (10%) and definite delay in diagnosis (i.e., a ‘missed’ cancer) occurred in only nine patients (31%). The overall diagnostic accuracy of ‘triple’ assessment is 99.6% and the ‘missed’ cancer rate is 1.7 per 1000 women discharged.
ISSN:0007-0920
1532-1827
DOI:10.1038/sj.bjc.6605082