1. 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

2. Breast Cancer outcomes- Early Dx Optimal 12341234 Stage

3. Tailored personal care 50-65 Family history risk

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

5. Moderate risk: Yearly from 40- 50yrs High risk: Imaging from >30yrs 1% genetic counselling

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

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

8. Results 143 57 Appropriately Inappropriately screened screened 200 patients

9. Stage at diagnosis n=200 % stage

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

11. Results 200 patients 112 88 no criteria Appropriate 31 Failed 57 met screening criteria

12. ResultsMeeting screening criteria patients 41 5 16 BC criteriaBC criteria & FH FH 57

13. met Breast Check criteria Declined offer Offer-Post diagnosis No offer 46 2515 6

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

15. Stage at presentation meeting screening criteria n=88 Stage % p-value 0.006 (0-2) (3&4)

16. 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

17. 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, 53-62. doi: 10.4236/abcr.2015.42006.10.4236/abcr.2015.42006

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