Characteristics and screening outcome of women referred twice at screening mammography

Objectives To determine the characteristics and screening outcome of women referred twice at screening mammography. Methods We included 424,703 consecutive screening mammograms and collected imaging, biopsy and surgery reports of women with screen-detected breast cancer. Review of screening mammograms was performed to determine whether or not an initial and second referral comprised the same lesion. Results The overall positive predictive value of referral for cancer was 38.6% (95% CI 37.3-39.8%). Of 147 (2.6%) women referred twice, 86 had been referred for a different lesion at second referral and 32 of these proved malignant (37.2%, 95% CI 27.0-47.4%). Sixty-one women had been referred twice for the same lesion, of which 22 proved malignant (36.1%, 95% CI 24.1-48.0%). Characteristics of these women were comparable to women with cancer diagnosed after first referral. Compared with women without cancer at second referral for the same lesion, women with cancer more frequently showed suspicious densities at screening mammography (86.4% vs 53.8%, P = 0.02) and work-up at first referral had less frequently included biopsy (22.7% vs 61.5%, P = 0.004). Conclusions Cancer risk in women referred twice for the same lesion is similar to that observed in women referred once, or referred for a second time but for a different lesion. Key Points . Cancer risk was 36% for lesions referred twice at screening mammography . The cancer risk was similar for lesions referred only once at screening . Densities at first referral were associated with increased cancer risk at second referral . No biopsy at first referral was associated with increased cancer risk at second referral . Patient and tumour characteristics were similar for women with and without diagnostic delay.