THE ABNORMAL MAMMOGRAM IN WOMEN WITH CLINICALLY NORMAL BREASTS

Objectives: To assess the impact of unnecessary referrals to breast su rgeons as a result of abnormal mammograms in women with clinically nor mal breasts and to determine measures to make the management of such w omen more efficient. Design: A case study. Setting: A breast clinic in a university-affiliated hospital. Patients: From among 6477 women ref erred for surgical breast assessment, 475 with asymptomatic, clinicall y normal breasts were referred solely on the basis of an abnormal mamm ogram. Interventions: Mammography and breast biopsy. Main Outcome Meas ures: Need for surgical assessment as a result of mammographic finding s, number of biopsies and the diagnosis of cancer. Results: Clinically a breast abnormality was evident in 63 (13%) women and a malignant le sion in 14 of them (2.9% of the total). Of the 412 women who were conf irmed as having clinically normal breasts, only 139 (33.7%) had mammog rams originally reported as suspicious for cancer. After the mammogram s were reviewed, 79% of women with such a suspicious mammogram underwe nt mammographic localization and biopsy: a malignant lesion was confir med 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%) require d a biopsy and only 40 (9.7%) had cancer. Conclusions: Most women refe rred because of an abnormal mammogram have no significant problem or h ave one that can be resolved without surgical referral. Screening effi ciency can be improved, patient anxiety controlled and cost controlled by a number of recommended measures.