Breastcheck: research shows diagnostic errors are nothing new
The Agency of Healthcare Research and Quality (AHRQ), in February 2006, released a review entitled Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities.
It indicated that common tests like mammography, ultrasound and MRI would miss between 4% and 9% of cancer cases among low-risk women testing negative, with potentially more missed cancers among women at higher risk.
Ellen Shaw, in an article entitled Missed Breast Cancer (Applied Radiology, 2000), presented data from the breast cancer detection demonstration project. She said that while mammography was the gold standard for the detection of early breast cancer, approximately 8%-10% diagnostic errors occur.
Double reading has been found to improve the sensitivity for breast cancer detection. Her article outlined the various factors that could lead to missed diagnosis, including 5% for technical errors (equipment). Several other papers cited a missed diagnosis rate ranging from 5% to 25%.
The quality of clinical examination, delayed clinical diagnosis and failure to follow up on radiologists’ reports also account for increased patient morbidity and mortality. Approximately nine cases were missed in the recent review of 3,000 cases — that is less than 1% error.
To think that this percentage was achieved by radiologists with no specialisation in breast radiology and equipment that is 15 years old! I’m sure everyone will agree — including breast radiologists around the world — that it is a damn good figure.
So, what is the whole drama of missed cancer? And then we had the case in the review clinic last Saturday when a lady with a high risk of cancer was not clinically followed up for nearly two years! If there is an lump on the present examination, it is not unusual. Interval lumps occur.
High-risk women should be closely reviewed by qualified breast surgeons.
Dr James Norton
Headford
Co Galway
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