Audit of Prior Screening Mammograms of Screen-Detected Cancers: Implications for the Delay in Breast Cancer Detection

Gopal R. Vijayargahavan, Jade Watkins, Monique Tyminski, Shambhavi Venkataraman, Nita Amornsiripanitch, Adrienne Newburg, Erica Ghosh, Srinivasan Vedantham

Research output: Contribution to journalReview articlepeer-review


When cancer is detected in a screening mammogram, on occasion retrospective review of prior screening (pre-index) mammograms indicates a likely presence of cancer. These missed cancers during pre-index screens constitute a delay in detection and diagnosis. This study was undertaken to quantify the missed cancer rate by auditing pre-index screens to improve the quality of mammography screening practice. From a cohort of 135 screen-detected cancers, 120 pre-index screening mammograms could be retrieved and served as the study sample. A consensus read by 2 radiologists who interpreted the pre-index screens in an unblinded manner with full knowledge of cancer location, cancer type, lesion type, and pathology served as the truth or reference standard. Five radiologists interpreted the pre-index screens in a blinded manner. Established performance metrics such as sensitivity and specificity were quantified for each reader in interpreting these pre-index screens in a blinded manner. All five radiologists detected lesions in 8/120 (6.7%) screens. Excluding the 2 readers whose performance was close to random, all the 3 remaining readers detected lesions in 13 pre-index screens. This indicates that there is a delay in diagnosis by at least one cycle from 8/120 (6.7%) to 13/120 (10.8%). There were no observable trends in terms of either the cancer type or the lesion type. Auditing prior screening mammograms in screen-detected cancers can help in identifying the proportion of cases that were missed during interpretation and help in quantifying the delay in breast cancer detection.

Original languageEnglish (US)
Pages (from-to)62-69
Number of pages8
JournalSeminars in Ultrasound, CT and MRI
Issue number1
StatePublished - Feb 2023


  • Breast cancer
  • Mammography
  • Missed cancer
  • Quality improvement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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