Failure to appropriately screen women according to international guidelines– what are the...
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![Page 1: Failure to appropriately screen women according to international guidelines– what are the consequences? Alison Johnston*, M Sugrue, S Curran Department.](https://reader036.fdocuments.us/reader036/viewer/2022070414/5697bffa1a28abf838cc09f3/html5/thumbnails/1.jpg)
Failure to appropriately screen womenaccording to international guidelines–
what are the consequences?
Alison Johnston*, M Sugrue , S Curran
Department of Breast Surgery, Letterkenny General Hospital and Donegal Clinical and Research Academy
![Page 2: Failure to appropriately screen women according to international guidelines– what are the consequences? Alison Johnston*, M Sugrue, S Curran Department.](https://reader036.fdocuments.us/reader036/viewer/2022070414/5697bffa1a28abf838cc09f3/html5/thumbnails/2.jpg)
Breast Cancer outcomes- Early Dx Optimal
1
2
3
4
Stage
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Tailored personal care
50-65
Family history risk
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Family history: assess risk level
17-29%<17% ≥30%
Low Moderate High
1<40 (Primary)
2 < 60 ( one Primary)
3 any age
![Page 5: Failure to appropriately screen women according to international guidelines– what are the consequences? Alison Johnston*, M Sugrue, S Curran Department.](https://reader036.fdocuments.us/reader036/viewer/2022070414/5697bffa1a28abf838cc09f3/html5/thumbnails/5.jpg)
Moderate risk:• Yearly from 40-
50yrs
High risk:• Imaging from
>30yrs• 1% genetic
counselling
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Aim
Assess appropriateness of breast screening in
patients newly diagnosed with breast cancer.
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Results – Patient Profile
200 female patients
mean age 61 ± 15.4 (range 28-99)
Previous mammogram 82/200 (41%)
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Results•
•
•
• 143 57
Appropriately Inappropriately
screened screened
200 patients
![Page 9: Failure to appropriately screen women according to international guidelines– what are the consequences? Alison Johnston*, M Sugrue, S Curran Department.](https://reader036.fdocuments.us/reader036/viewer/2022070414/5697bffa1a28abf838cc09f3/html5/thumbnails/9.jpg)
Stage at diagnosis n=200
0
10
20
30
40
50
60
70
80
90
100
0 1 2 3 4
Appropriately sc reened
Inappropriately sc reened
%
stage
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Tumour size (mm)n=200
mm
20
24
28
32
36
40
appropriately
screened
inappropriately
screened
appropriatelyscreenedinappropriatelyscreened
Yates' p-value 0.001
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Results200 patients
112 88
no criteria
Appropriate 31 Failed
57
met screening criteria
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Results Meeting screening criteria
patients
41 5 16
BC criteria BC criteria & FH FH
57
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met Breast Check criteria
Declined offerOffer-Post diagnosis
No offer
46
25 15 6
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Nodal status- meeting screening criteria n=88
%
P-value 0.02
Negative Positive0
10
20
30
40
50
60
70
80
90
100 Appropriate
Inappropriate
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Stage at presentationmeeting screening criteria n=88
Early Later0
102030405060708090
100 Appropriate
Inappropriate
Stage
%
p-value 0.006(0-2) (3&4)
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Conclusion
• Failure to risk assess and screen >25% of all breast cancer presentations
• Those with high risk/screening criteria failure in 65%
• Failure to screen More advanced cancer
• Donegal will continue to have poorer outcome if delayed presentations continue
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Johnston, A. Curran, S. and Sugrue, M. (2015) Failure to Engage in Breast Screening and Risk Assessment Results in More Advanced Stage at Diagnosis. Advances in Breast Cancer Research, 4, 53-62. doi: 10.4236/abcr.2015.42006.
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Outcomes:
Contacted key stakeholders:
• NCCP
• Breast Check
• GPs in county
• Women’s Groups
• Local radio and press
• Follow on study
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