Missed cancers on mammograms: Causes and measures of prevention

Mammographically missed breast cancers remain a major medical and legal issue. In order to clarify causes and methods of the limitations, we present the experience of our Unit on this field. During the years 1999 and 2000, 319 breast cancer patients were admitted for surgical treatment to our Unit. Their files were reviewed in order to identify cases with mammography-related delayed diagnosis. Thirty-three cases of mammographically missed cancers were found (10.3%). The usual reasons for the delayed diagnoses were: retrospectively visible cancers, in benign looking lesions no further action was taken, and lesions with a rather malignant appearance were reported as benign. Missed cancers could be reduced by simple measures such as the full assessment of breast patients with clinical, radiologic, and cytologic-histologic evaluation, the double screening of mammograms, and improvement of the mammographic equipment and technique.

Mammography; Breast cancer; Missed cancer

[1] Mitnick J.S., Madeline F., Vazquel M.F., Plesser K.P., Roses D.F.: "Breast cancer malpractice litigation in New York State". Radio!ogy, 1993, 189, 673.

[2] Kern K.A.: "Causes of breast cancer malpractice litigation: a 20- year civil court review". Arch. Surg., 1992, 127, 542.

[3] Wang J.,S hih TT.,H su J.C.,L i Y.W.:'The evaluation of false negative mammography from malignant and benign breast lesions" Clin. Imaging, 2000, 24, 96.

[4] Goodson W.H. 3'',M oore D.H. 2"': "Causes of physician delay in the diagnosis of breast cancer". Arch. In1ern. Med., 2002, 162, 1343.

[5] Bird R.E., Wallace T.W., Yankaskas B.C.: "Analysis of cancers missed at screening mammography". Radiology, 1992, 184, 613.

[6] Foxcroft L.M., Evans E.B., Joshua H.K., Hirst C.: "Breast cancers invisible on mammography". Auslr. N.Z.J. Surg., 2000, 70, 162.

[7] Berlin L.: "The missed breast cancer redux: time for educating the public about the limitations of mamography?". Am. J. Radiol., 2001, 176, 1131.

[8] Hall FM.: "When is it malpractice to miss breast cancers on mammograms?" Radiology, 1990, 176, 876.

[9] Baines C.J., McFarland D.V., Miller A.B.:'The role of the reference radiologist. Estimates of the interobserver agreement and potential delay in cance detection in the national breast screening study". Invest. Radiol., 1990, 25, 971.

[10] Thurfjell E.L., Lernevall K.A., Taube A.A.: "Benefit of independent double reading in a population-based mammography screening program". Radiology, 1994, 791, 241.

[11] Patel M.R., Whitman G.J.: "Negative mammograms in symptomatic patients with breast cancer". Acad. Radiology, 1998, 5, 26.

[12] Birdwell R.L., Ikeda D.M., O'Shaughnessy K.F., Sickles E.A.: "Mammographic characteristics of 115 missed cancer later detected with screening mammography and the potential utility of computer-aided detection". Radiology, 2001, 219, 192.

[13] Markopoulos C., Kouskos E., Koufopoulos K., Kyriakou V., Gogas J.: "Use of artificial neural network (computer analysis) in diagnosis of clustered microcalcifications on mammograms". Eur. J. Radiol., 2001, 39, 60.

[14] Yankaskas B.C., Schell M.J., Bird R.E., Desrochers D.A.: "Reassessment of breast cancers missed during routine screening mammography". Am. J. Radiol., 2001, 177, 535.