Breast Screening and Assessment Women's Cancer Screening Collaborative March 2017
Forms of Health Tests Population Based Screening Opportunistic Screening Targeted Risk Screening Routine Exam or Planned Opportunistic Screening Diagnostic Testing
Forms of Health Tests Population Based Screening Opportunistic Screening Targeted Risk Screening Routine Exam or Planned Opportunistic Screening Diagnostic Testing
Symptomatic Clinical Abnormality High Risk < 40 yo Diagnostic Testing
Asymptomatic No Clinical Findings Target Age Group Population Based Screening Asymptomatic No Clinical Findings Target Age Group
Ideal Breast Process Detect Diagnose Treat Asymptomatic No Clinical Findings Target Age Group Screening Read Assessment Clinic Breast Surgeon Symptomatic Clinical Abnormality High Risk < 40 yo GP Consult Diagnostic Radiology
Real Breast Process Detect Diagnose Treat Asymptomatic No Clinical Findings Target Age Group Screening Read Assessment Clinic Breast Surgeon Symptomatic Clinical Abnormality High Risk < 40 yo GP Consult Diagnostic Radiology
Screening Read Asymptomatic No Clinical Findings Target Age Group GP Consult Diagnostic Radiology
Screening Benefits Free Optimised to serve asymptomatic population Formal read process Sensitivity and Specificity tightly controlled Robust continuous QA Proven cost/benefit if asymptomatic
Diagnostic Radiology Benefits Variable cost Optimised to solve diagnostic problems Increased sensitivity Low specificity? Variable read QA process Absolutely right for symptomatic Risk of overbiopsy in asymptomatic?
Real Breast Process Detect Diagnose Treat Asymptomatic No Clinical Findings Target Age Group Screening Read Assessment Clinic Breast Surgeon Symptomatic Clinical Abnormality High Risk < 40 yo GP Consult Diagnostic Radiology
Right Tool for the Job
North Coast Service Screen 30000 Read 1000 Assess Biopsy 150 Treat
North Coast Service
North Coast Service
North Coast Service
Reading Agree Rescreen Read 1 and 2 Disagree Assess Read 3
Assessment Clinical X-Ray Ultrasound Highest Score DECISION TIME!! Normal Biopsy Review
Current Controversies Tomosynthesis in Screening Overdiagnosis Breast Density
On the Horizon? Personalised Screening Automated Breast Ultrasound Contrast enhanced mammography Increasing role of MRI Artificial Intelligence image interpretation Minimally Invasive Breast Therapy
Asymptomatic No Clinical Findings Target Age Group Population Based Screening Asymptomatic No Clinical Findings Target Age Group