Learning from mammography mistakes: 7 keys to avoiding missed breast cancer diagnoses

It is estimated that approximately one-third of recently diagnosed breast cancers are visible in patients’ previous mammograms, having been either missed completely by the radiologist or possibly misinterpreted as benign.

While unfortunate and far too frequent, these mistakes represent a golden opportunity to investigate why some breast cancers initially go unnoticed and how to improve the process to reduce the impact of missed diagnoses, said Anubha Wadhwa, MD, and his co-authors from the Medical College of Wisconsin in Milwaukee, in an article recently published in the journal Current Problems in Diagnostic Radiology.

“Studying the imaging findings of cancers that went undetected is a good learning exercise for the radiologist to identify common patterns and mistakes that lead to a missed cancer,” they wrote. “This allows the radiologist to improve mammographic sensitivity and overall diagnostic accuracy.”

Wadhwa and his team conducted a literature review of existing research regarding missed breast cancers and created seven key points for radiologists to remember when interpreting mammography studies.

1. Pay attention to the subtle features of malignancy, both on mammography and ultrasound.
2. Do not make a diagnosis on a screening mammogram. Always obtain adequate diagnostic work-up such as magnification views, spot compression views, or ultrasound.
3. If a finding catches your attention on the mammogram, look at multiple prior mammograms, to evaluate for a possible subtle developing change.
4. A developing asymmetry merits a tissue diagnosis, especially if there are associated microcalcifications, architectural distortion, or if the finding is palpable.
5. Be very particular about patient positioning and proper examination technique. A good quality assurance program is essential.
6. Always act on the most worrisome feature of the lesion.
7. If the pathology result obtained after biopsy does not explain the imaging finding, repeat core biopsy or surgical excision is warranted.

“Our aim in screening mammography should be to detect a cancer at its earliest possible stage, which requires a good knowledge of the subtle features of malignancy and also a good radiographic technique,” the authors concluded. “By performing quality mammograms with proper positioning, paying attention to the subtle signs of malignancy, using multiple prior mammograms for comparison and judging a lesion by its most malignant feature, we can improve the detection of breast cancer.”