[Sensitivity and specificity of the breast screening program in the Isere region based on positive results between 1991 and 1999]. / Analyse de la sensibilité et de la spécificité des mammographies en fonction des taux de tests positifs dans le programme de dépistage organisé de l'Isère de 1991 à 1999.

PURPOSE: The screening program guidelines specify that the call back rate of women for additional imaging (positive mammogram) should not exceed 7% at initial screening, and 5% at subsequent screening. Materials and methods. Results in the Isere region (12%) have prompted a review of the correlation between the call back rate and indicators of quality (detection rate, sensitivity, specificity, positive predictive value) for the radiologists providing interpretations during that time period. RESULTS: Three groups of radiologists were identified: the group with call back rate of 10% achieved the best results (sensitivity: 92%, detection rate: 0.53%, specificity: 90%). The group with lowest call back rate (7.7%) showed insufficient sensitivity (58%). The last group with call back rate of 18.3%, showed no improvement in sensitivity (82%) and detection rate (0.53%), but showed reduced specificity (82%). CONCLUSION: The protocol update in 2001 does not resolve this problematic situation and national results continue to demonstrate a high percentage of positive screening mammograms. A significant increase in the number of positive screening examinations compared to recommended guidelines is not advantageous and leads to an overall decrease in the quality of the screening.

Analysis and classification of interval cancers in a French breast cancer screening programme (département of Isère).

The objective of this study is to analyse detection rates and stage of diagnosis of interval cancers in the mass screening mammography programme of Isère (France), launched in 1990. Interval cancers are defined as breast cancers diagnosed within 30 months after a negative screening assessment, for women attending the programme between November 1990 and December 1994. Stages of diagnosis of these cancers are compared with those of screened cancers and to those of cancers diagnosed outside the programme. The rates of invasive interval cancers are 17.7% of the expected incidence rate during the first year, 60.0% during the second year and 58.8% after the second year. Sensitivity of the programme (one test every 30 months) is 74%; sensitivity at one year is 82%. Results are better for women aged 60-69 years than for younger women (50-59 years). Diagnosis is made at an early stage with 8% of in situ cases, and with 40% of very small tumours (sizes < or = 10 mm). Those stages are very close to the ones for screened cases. Interval cancer rates are low during the first year. Higher rates for the second year and early stages of diagnosis could be explained by self-referred screening practice in our area.

[Simultaneous screening of cancers of the breast, cervix, colon and rectum. The Isère experience]. / Dépistage simultané des cancers du sein, du col utérin, du côlon et du rectum. Expérience de l'Isère.

The mass screening program for cancer in the Isere department offers women between 50 and 69 years a medical consultation and three tests: mammography for breast cancer screening, Pap smear for cervical cancer screening, and hemoccult for colorectal cancer. During the first round, 29,570 women took part in the program, 21% had a mammography, 20% Pap smears and 25% a hemoccult. In breast cancer screening, the rate for further examination was 11.9%, the breast cancer detection rate was 5.4 per 1,000 women screened and the detection rate of invasive tumor < or = 10 mm: 2.0 per 1,000. In cervical cancer screening, the rate of abnormal examinations was 1.2%. The cervical cancer detection rate was 1.5 per 1,000. The rate of positive hemoccult was 2.7% and the rate of colorectal cancers and polyps 10 mm or larger was 2.7 per 1000. Results of screening are satisfying, but compliance rate is too low. Acceptance rate must be examined in following rounds.

Isolated clustered microcalcifications: diagnostic value of mammography--series of 400 cases with surgical verification.

PURPOSE: To determine the diagnostic value of mammographic criteria in cases of isolated clustered microcalcifications. MATERIALS AND METHODS: Four hundred mammographic studies of isolated clustered microcalcifications for which surgical verification was available were reviewed. A descriptive statistical study was performed to evaluate the distribution of each criterion relative to histopathologic results, followed by a multivariate study to determine statistically significant criteria. Seven breast specialists gave a consensus opinion on the need for surgery. RESULTS: There were 302 benign lesions and 98 cancers. The most useful criteria were vermicular form, linear/branching shape, and irregular size of microcalcification. The number of biopsies recommended with use of these three criteria was 177 instead of the 172 recommended by the experts. CONCLUSION: Use of these three preoperative criteria permits correct diagnosis of most such malignancies (90% in our series vs 67% diagnosed by the experts).