The abnormal mammogram in women with clinically normal breasts.

OBJECTIVES

To assess the impact of unnecessary referrals to breast surgeons as a result of abnormal mammograms in women with clinically normal breasts and to determine measures to make the management of such women more efficient.

DESIGN

A case study.

SETTING

A breast clinic in a university-affiliated hospital.

PATIENTS

From among 6477 women referred for surgical breast assessment, 475 with asymptomatic, clinically normal breasts were referred solely on the basis of an abnormal mammogram.

INTERVENTIONS

Mammography and breast biopsy.

MAIN OUTCOME MEASURES

Need for surgical assessment as a result of mammographic findings, number of biopsies and the diagnosis of cancer.

RESULTS

Clinically a breast abnormality was evident in 63 (13%) women and a malignant lesion in 14 of them (2.9% of the total). Of the 412 women who were confirmed as having clinically normal breasts, only 139 (33.7%) had mammograms originally reported as suspicious for cancer. After the mammograms were reviewed, 79% of women with such a suspicious mammogram underwent mammographic localization and biopsy: a malignant lesion was confirmed in 36.4% of these. Of the 475 women referred for assessment, only 202 (42.5%) had a significant clinical or mammographic abnormality. Of the 412 women with clinically normal breasts only 110 (26.7%) required a biopsy and only 40 (9.7%) had cancer.

CONCLUSIONS

Most women referred because of an abnormal mammogram have no significant problem or have one that can be resolved without surgical referral. Screening efficiency can be improved, patient anxiety controlled and cost controlled by a number of recommended measures.