title: Classification of findings in mammography screening--a method to minimise recall anxiety?
abstract: OBJECTIVE
  The aim was to find out if it is possible, by classifying screening mammograms according to the likelihood of malignancy, to divide the recalled women to a group in which there is high suspicion of malignancy, most having breast cancers, and a group with more obscure findings.
  
  
  METHODS
  Screening mammograms of recalled women were classified according to the likelihood of malignancy. 0 = technically insufficient, 1 = normal, 2 = benign tumour, 3 = malignancy cannot be excluded, 4 = strongly suspicious for malignancy, 5 = malignant.
  
  
  METHODS
  This study was a population based survey of mammography screening in Helsinki and surroundings in Finland.
  
  
  METHODS
  21,417 women (aged 50-59 years) were invited to be screened, 18,012 (84.10%) participated. Of these 579 (3.21% of those screened) were recalled for further studies; 124 of these were referred for surgical biopsy and 82 had breast cancer.
  
  
  RESULTS
  All cases classified as 5, 60% of the cases classified as 4, 6.5% of the cases classified as 3, 0% of the cases classified as 2 or 1, and 1.2% of the cases classified as 0 proved to have breast cancers. However classification 5 represented 5.9% of all recalled women and 41.5% of all screening detected breast cancers; classification 4, 6.0% of all recalled women and 25.6% of all screening detected breast cancers; classification 3, 68.9% of all recalled women and 31.7% of all screening detected breast cancers; classification 2, 11.7% and classification 1, 2.9% of all recalled women. No breast cancers were detected with these classifications. Classification 0 represented 4.5% of all recalled women and 1.2% of all screening detected breast cancers. Classifications 5 and 4 represented only 11.9% of all recalled women but 67.1% of all screening detected breast cancers.
  
  
  CONCLUSIONS
  By classifying screening mammograms according to the likelihood of malignancy, recalled women can be divided into two groups: (1) a quite small subgroup in which everyone or almost everyone will be shown to have breast cancer; and (2) a much larger subgroup in which only a few will be proven to have breast cancer. The invitation procedure for the further studies should be improved on this basis of minimising anxiety among recalled women.
authors.affiliation: Mammography Screening Centre, Cancer Society of Finland, Helsinki.
authors.forename: M
authors.initials: M
authors.lastname: Pamilo
authors.forename: J
authors.initials: J
authors.lastname: Lönnqvist
authors.forename: A
authors.initials: A
authors.lastname: Halttunen
authors.forename: M
authors.initials: M
authors.lastname: Soiva
authors.forename: I
authors.initials: I
authors.lastname: Suramo
mesh_terms: D001007:Anxiety / Q000517:prevention & control*; D001943:Breast Neoplasms / Q000523:psychology*; D005260:Female; D005387:Finland; D006801:Humans; D008327:Mammography / Q000523:psychology*; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D012017:Referral and Consultation