Mammogram Call Backs - Not Such a Bad Thing Everyday Health MenuNewslettersSearch Breast Cancer News Fewer Call Backs From Mammography Screening Centers Linked With More Missed Cases of Breast CancerA new study suggests that breast cancer screening centers should establish and adhere to a minimum recall rate. By Shari RoanApril 6, 2018Everyday Health ArchiveFact-CheckedSome centers should be doing more mammogram call-backs. ShutterstockUndergoing a second, or recall, mammogram for a suspicious finding is an anxiety-producing event that many women have experienced. But a new study indicates that breast centers with a low rate of recalls may be missing too many cases of breast cancer. The study, published April 3, 2018, in the journal Radiology, attempted to establish a minimum recall rate for breast cancer screening centers. This is a rate that balances detecting cancer early without unnecessarily inconveniencing large numbers of women or wasting healthcare dollars. While breast cancer screening programs in the United States routinely establish maximum recall rates (the percentage of recalls a screening program does not want to exceed), the study strongly suggests that programs should also establish and adhere to minimum recall rates to ensure that cancers aren’t missed. “There has been quite a bit of debate to try to understand whether recall rates really do vary with the clinically important cancers,” says the lead author of the study, Elizabeth S. Burnside, MD, a professor of radiology from the University of Wisconsin School of Medicine and Public Health in Madison, Wisconsin. “This is the first time that it’s been shown that recall rates really matter, and you can get too low. When you get too low, the value of breast cancer screening decreases because you are missing cancers.” Mammogram Recalls Finding the Balance Between Too Many and Too Few Maximum recall rates are based on data showing diminishing benefit relative to the potential harms associated with recall mammography, such as the costs linked to additional testing and anxiety for the woman. Screening centers aim to avoid having the number of false-positive test results (when the initial screening suggests cancer but follow-up testing establishes that there is no cancer) outweigh the benefits of finding cancer early. But there is much less information on whether there is value to establishing a minimum recall rate. In the United States, there are no enforced requirements for cancer detection rates and recall rates. Dr. Burnside and her colleagues used a mammography database in the United Kingdom because that country has established a detailed mammography data collection program, a type of database that does not exist in the United States. They analyzed 5,126,689 screenings from 84 screening facilities in the U.K. National Health Service Breast Screening Program. The data reflected a 36-month period, with a three-year follow-up, in women ages 50 to 70. Researchers homed in on the average recall rate and the interval cancer rate. Interval cancers are those cancers that are detected between cancer screenings. The study found that lower recall rates are linked to higher interval cancer rates. Recall rates averaged 4.56 percent, with an interval cancer rate of 3.1 per 1,000 women screened. The researchers estimated that, in aggregate, 80 to 84 additional recalls would be required to avoid one interval cancer. The recall ratio varies based on factors such as age. Rates of cancer detection and interval cancer were lower in younger women, while the recall rate had more of an impact on older women. “The reason we studied this in the U.K. is because they had data available on a really large population basis. It’s very comprehensive and collected carefully,” Burnside says. “We aren’t able to study that question in the U.S. because we don’t have the rigorous collection of outcomes data, including these important interval cancers. We found there is a relationship between recall rate and interval cancers — those cancers that will show up clinically if not detected on mammogram.” Improving the Process in the United States The study provides breast cancer screening centers with a methodology to determine a minimal recall rate threshold that is a balance between too few and too many recall screenings. Recall rates in the United States range from 5.5 to 12 percent. The rates differ according to other risk factors, such as age and breast density. Previous studies show recall rates vary among screening centers. “Although we aren’t able to state, based on this paper, what exact ranges are optimal for every given program, the important message is that recalls do have value, and within certain ranges, recalls are going to help detect important cancers earlier,” she says. The study only examined data based on traditional X-ray film mammography. Future studies should look at recall rates using the more modern digital mammography, which replaces traditional X-ray film. The study authors also advocate for better data collection in the United States — data that can then be analyzed to improve screening guidelines. “We should be collecting the data and studying that to make more rigorous decisions about what our optimal ranges are,” Burnside says. “Continual learning is so valuable. One of the real important messages of this study is the value of rigorous collection of data and utilizing that data to understand a better way to screen. Centralized resources are the best way to create a comprehensive view. I would hope we, and all programs, would aspire to that.” What If You Get a Phone Call Summoning You for a Repeat Mammogram Women undergoing screening mammography should remember that although being recalled for a second exam is stressful, it typically means that radiologists are being prudent and careful, Burnside says. “The vast majority of recalls are not cancer,” Burnside says. “If women can remember not to get too worried about recall, that’s important. It doesn’t necessarily mean you have cancer. The important message is that recalls do have value, and within certain ranges, recalls are going to help detect important cancers earlier.” NEWSLETTERS Sign up for our Cancer Care Newsletter SubscribeBy subscribing you agree to the Terms of Use and Privacy Policy. 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