Double Independent Reading at Screening Mammography with Arbitration at the University Hospital of the West Indies: The initial experience

摘要

Aim: To evaluate the initial experience with the first double independent reading at screening mammography in JamaicaMethod: This was a retrospective review of all patients presenting to the Breast Imaging Unit for Screening Mammography at the University Hospital of the West Indies from October 2006 to April 2007Results: A total of 368 women were screened. Of these, 101 were undergoing their first screening mammogram. 77 had done one previous mammogram. 190 women had done more than 2 mammograms. The age of the women screened ranged from 36 to 90 years of age. The mean age was 55 years. 36 women were considered abnormal. 36 women were considered abnormal. Suspicious microcalcification was the most common abnormality reported. No malignancies were confirmed at histopathological evaluation.Conclusion: The recall rate in our study was very low. No cancers were detected. This is likely due to the small sample size. Detection rates are not likely to improve unless more eligible women participate in breast cancer screening in Jamaica. Introduction Breast cancer is a leading cause of death and morbidity amongst Jamaican women1. Mammographic screening has been shown to reduce mortality rates from breast cancer in women over 402. Screening can only be effective if the at-risk population avail themselves of the facility. Recent data suggests that less than 5% of Jamaican women eligible for mammographic screening actually have mammograms3.Mammography services are available at the public sector facilities of the University Hospital of the West Indies, as well as the St. Ann’s Bay Hospital. There are also at least seven private centres across the island that also offers the service and one non-governmental organization the Jamaica Cancer Society. The University Hospital of the West Indies (UHWI) is affiliated academically with the University of the West Indies. Screening mammography at UHWI began in 1997 when the breast-imaging unit was initially installed. Although a regional [this is unclear, regional may seem to mean a region of Jamaica rather than the Caribbean Region] facility, the majority of its clients come from the eastern parishes of Kingston and St. Andrew with a combined female population aged 40 years and over of just over 95,0004 Initially at UHWI, due to staffing constraints, a single radiologist read all mammograms individually. In October 2006, a double independent system of reading mammograms was implemented. This involved: Two radiologists are assigned to screening cases each week These radiologists individually read each screening study independent of each other, at different times Each film is second read after the first reader The second reader is blinded All screening cases for the week are brought to an arbitration meeting at the beginning of the following week. At arbitration: Cases reported normal by both readers go for typing Where cases reported abnormal by both readers the decision as to what should be done at recall is made by all three radiologists In cases where there is disagreement in the findings (i.e. reported normal by one reader and abnormal by the other), the final decision is made by the arbitrator. Patients considered suitable for screening must be: Forty years and older Asymptomatic These women may be referred by their primary care physician or other medical doctor, or may be self referred.All patients in whom it is determined that tissue sampling is required, are referred to the General Surgery service for clinical evaluation and follow-up of the histology results.At present, no similar breast screening system exists in Jamaica. Given the separation of patients into screening and symptomatic populations, an unprecedented opportunity now exists for the evaluation of true screening mammography in terms of: Actual number of patients presenting for true screening (i.e. asymptomatic patients in the screening age) True positives False positives The aim of this study is to evaluate the initial experience