Failure to appropriately screen women according 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

Breast Cancer outcomes- Early Dx Optimal Stage

Tailored personal care Family history risk

Family history: assess risk level 17-29% <17% ≥30% Low Moderate High 1<40 (Primary) 2 < 60 ( one Primary) 3 any age

Moderate risk: Yearly from yrs High risk: Imaging from >30yrs 1% genetic counselling

Aim Assess appropriateness of breast screening in patients newly diagnosed with breast cancer.

Results – Patient Profile 200 female patients mean age 61 ± 15.4 (range 28-99) Previous mammogram 82/200 (41%)

Results Appropriately Inappropriately screened screened 200 patients

Stage at diagnosis n=200 % stage

Tumour size (mm) n=200 mm Yates' p-value 0.001

Results 200 patients no criteria Appropriate 31 Failed 57 met screening criteria

ResultsMeeting screening criteria patients BC criteriaBC criteria & FH FH 57

met Breast Check criteria Declined offer Offer-Post diagnosis No offer

Nodal status- meeting screening criteria n=88 % P-value 0.02

Stage at presentation meeting screening criteria n=88 Stage % p-value (0-2) (3&4)

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

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, doi: /abcr /abcr

Outcomes : Contacted key stakeholders: NCCP Breast Check GPs in county Women’s Groups Local radio and press Follow on study