Mammographic surveillance in family history patients: Do low cancer detection rates justify the high numbers of breast cancers detected?

Introduction: NICE recommends that women at increased risk of breast cancer due to family history (FH) should undergo enhanced mammographic screening. We examined the performance of the Belfast Trust FH screening programme for women aged 35–70 between January 2010 and June 2016. Methods: Eligible women were identified from the Belfast Trust FH database. Known risk-predisposition mutation carriers were excluded. Mammogram reports, details of additional investigations and characteristics of tumours detected were obtained using computerised reporting systems. Recall rates and cancer detection rates were calculated for the overall cohort and by year, and by age and risk groups. Results: 2384 women were screened between 2010 and 2016 (9108 mammograms) and 40 cancers detected. The overall recall rate was 7.5% (versus 3.7% NHSBSP); the cancer detection rate was 2.5 per 1000 mammograms (versus 6.8 per 1000 NHSBSP). Twenty-three cancers were diagnosed mammographically (57.5%), and 17 (42.5%) interval cancers were detected. Recall rates fell with increasing age (8.3% in the <40 age group to 4.3% in the 60–69 age group). There was a concomitant increase in cancer detection rates (0% to 4.3% per 1000 in these groups). There was no apparent trend in either recall or detection rates by year or by risk group. Conclusions: FH surveillance resulted in high recall rates, particularly in younger women, although cancer detection rates were low. The interval cancer rate was noted to be high, with 42.5% of cancers presenting clinically, suggesting that clinical assessment remains an important component of FH surveillance.