Independent review into digital screening mammograms

The findings of a comprehensive system-wide independent review into BreastScreen SA’s (BSSA) lower than expected cancer detection rates from digital screening technology have been released.

The review, led by independent breast screening expert and BreastScreen NSW’s State Radiologist, Associate Professor Warwick Lee, involved the of re-reading 53,104 sets of digital screening mammograms with a normal result undertaken between 6 September 2010 and 30 June 2012.

Associate Professor Warwick Lee’s findings and recommendations are outlined in the Digital Mammography System-wide Review Report (PDF 4MB).

The review found that screen reading practices, in particular a reduction in recall rates, were identified as the major cause of the reduced cancer detection rates.

In addition, the review found sub-optimal hanging protocols, possible poor soft copy reading practices and image quality issues were likely contributing factors.

Following the re-read process 570 women were recalled for further assessment at BSSA and a total of 72 cancers that were potentially detectable at the time of initial screening have been identified.

56 of these cancers were found through the re-read process. A further 16 interval cancers were classified as having been potentially detectable by a separate re-read process in relation to women who had already been diagnosed with interval cancers.

Please refer to the Frequently Asked Questions information sheet (PDF 386KB) for further information on the review findings and recommendations.

SA Health’s response to the report

BreastScreen SA will implement all of the recommendations made in response to the independent review. A number of recommendations are already underway or have been implemented following BreastScreen SA’s own investigations.

As a result, the rate of recall to assessment since the period of review has gone up and cancer detection rates have also shown significant improvement.

An implementation plan is being developed to ensure the remaining recommendations are actioned as soon as possible.

Further information

For further information, support or counselling please contact the BreastScreen SA on 13 20 50 between the hours of 8.30 am and 5.00 pm Monday to Friday.

Why a review was needed

The independent review into digital screening was commissioned in December 2012 following lower than expected breast cancer detection rates in comparison to past statistical trends and coinciding with the introduction of digital screening technology.

The review looked at aspects of the digital screening process including:

  • a panel of independent radiologists re-reading cleared, stored digital mammogram images taken during the specified timeframe to check the results;
  • a review of the implementation of the digital technology, the radiography services, and the picture archive, communication system and data management processes used by BreastScreen SA; and
  • an audit of all the data by an epidemiologist and a re-testing of the digital technology equipment.

Who was included in the review?

All women who had a digital screening mammogram at BreastScreen SA during the period 6 September 2010 and 30 June 2012, with a normal result were included in the review except for the following:

  • Those who had an analogue mammogram
  • Those who had a second normal digital mammogram during this time
  • Those who were recalled to the BreastScreen SA Assessment Clinic during this time.

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