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Review
. 2023 Jun:69:431-440.
doi: 10.1016/j.breast.2023.05.001. Epub 2023 May 3.

The dilemma of recalling well-circumscribed masses in a screening population: A narrative literature review and exploration of Dutch screening practice

Tanya D Geertse  1 , Daniëlle van der Waal  2 , Willem Vreuls  3 , Eric Tetteroo  4 , Lucien E M Duijm  3 , Ruud M Pijnappel  5 , Mireille J M Broeders  6
Affiliations
Review

The dilemma of recalling well-circumscribed masses in a screening population: A narrative literature review and exploration of Dutch screening practice

Tanya D Geertse et al. Breast. 2023 Jun.

Abstract

Background: In Dutch breast cancer screening, solitary, new or growing well-circumscribed masses should be recalled for further assessment. This results in cancers detected but also in false positive recalls, especially at initial screening. The aim of this study was to determine characteristics of well-circumscribed masses at mammography and identify potential methods to improve the recall strategy.

Methods: A systematic literature search was performed using PubMed. In addition, follow-up data were retrieved on all 8860 recalled women in a Dutch screening region from 2014 to 2019.

Results: Based on 15 articles identified in the literature search, we found that probably benign well-circumscribed masses that were kept under surveillance had a positive predictive value (PPV) of 0-2%. New or enlarging solitary well-circumscribed masses had a PPV of 10-12%. In general the detected carcinomas had a favorable prognosis. In our exploration of screening practice, 25% of recalls (2133/8860) were triggered by a well-circumscribed mass. Those recalls had a PPV of 2.0% for initial and 10.6% for subsequent screening. Most detected carcinomas had a favorable prognosis as well.

Conclusion: To recognize malignancies presenting as well-circumscribed masses, identifying solitary, new or growing lesions is key. This information is missing at initial screening since prior examinations are not available, leading to a low PPV. Access to prior clinical examinations may therefore improve this PPV. In addition, given the generally favorable prognosis of screen-detected malignant well-circumscribed masses, one may opt to recall these lesions at subsequent screening, if grown, rather than at initial screening.

Keywords: Breast cancer; False positive screening outcomes; Probably benign lesions; Screening population; Well-circumscribed masses.

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Conflict of interest statement

Declaration of competing interest The authors of this manuscript certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was performed under the national permit for breast cancer screening issued by the Ministry of Health, Welfare and Sports and did not require additional approval by a local institutional review board.

Figures

Fig. 1
Fig. 1
Flowchart of the literature search.
Fig. 2
Fig. 2
Screening mammography results of women recalled with BI-RADS 0 based on a well-circumscribed mass in a Dutch screening region in het period 2014–2019.
Image 1
True-positive (TP) and false-positive (FP) screen results per 1000 women screened for A: regular subsequent, and B: initial screens, 1990-2011
See this image and copyright information in PMC

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