Recall to assessment

Published

20 Nov, 2018

The proportion of women recalled for assessment due to an abnormal breast screen is a key performance indicator in the national breast screening program. To ensure that all women receive high quality breast screening services, BreastScreen Australia’s National Accreditation Standards (NAS) measures include the monitoring and reporting of the proportion of women aged 50–74 years among those who attend for their first screening episode, or second or subsequent screening episode, who are recalled for assessment.¹

Summary

Just over one in ten women are recalled for further investigation after their initial breast screenIn 2016, 11.3% of women in the target age range of 50–74 years were recalled for further investigation (assessment) after their first breast screen.  

Recall to assessment rates for breast screening have increased since 1996Among women in the age range 50–69 years, recall to assessment rates increased from 5.8% in 1996 to 11.2% in 2016 after their first screen. This trend correlates with an increase in detection rates of invasive breast cancers during that time.

Data

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First screen / subsequent screen

Notes

• Data sourced from AIHW BreastScreen Australia monitoring reports.
• Rates are age-standardised to the population of women attending a BreastScreen Australia service in 2008.

Proportion of females in target age range recalled for assessment following a breast screen, 1996 to 2015
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Notes

• Data sourced from AIHW BreastScreen Australia monitoring reports.
• Rates are not age-standardised.

Proportion of females in target age range recalled for assessment following a breast screen, by age group, 1996 to 2016
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Notes

• Data source for England is the Health and Social Care Information Centre.
• England data for 2004–05 are for women aged 50–64 years, as compared with women aged 50–70 years in 2014–15. Australian data are for women aged 50–69 years.
• Rates are not age-standardised.

Proportion of women being recalled to assessment following a breast screen in Australia and England, over a ten year period

About this measure

Breast cancer is the most common cancer reported in Australian women by Australian Cancer Registries. It is projected that in 2018, 18,087 females and 148 males will be diagnosed with this disease, and that it will remain the 4^th most common cause of death from cancer.² It is also estimated, using these data, that the risk of a female in Australia dying from breast cancer by her 85^th birthday will be about 1 in 41.²

Breast screening aims to detect breast cancers in asymptomatic women, thereby enabling intervention at an early stage of disease and, as a result, better survival outcomes.¹A breast screen which shows suspicious signs of breast cancer will generally lead to a recall of the woman for further investigation by a multidisciplinary team at an assessment centre.¹Recall to assessment rates are generally analysed separately for first and subsequent screening rounds because women are more likely to be recalled to assessment after their first breast screen than after subsequent screens.³

Australian governments have made early detection of breast cancer a priority, with the BreastScreen Australia program receiving funding support from Commonwealth and state/territory governments since 1990. The program originally focused on biennial screening of women aged 50–69 years, but the Federal Budget in 2013-14 allowed for extension of the BreastScreen Australia program from July 2013 to include women aged 70–74 years. Recall to assessment data are reported for the target age range of 50–74 years for 2015 onwards.

Current status

In 2016, 11.3% of women aged 50–74 years were recalled for further investigation (assessment) after their first breast screen (age-standardised data). For women aged 50–74 years who were attending a second or later (subsequent) screen, 3.7% were recalled for assessment.⁶

The recall to assessment rate was similar across the different age groups in the target age range for both first and subsequent breast screens.⁶

Trends

Trend data are only available for females aged 50–69 years. From 1996 to 2016, the proportion of females in the target age range who were recalled to assessment after their first breast screen increased from 5.8% in 1996 to 11.2% in 2016 (age-standardised data). Over the same time period, the proportion of women aged 50–69 years being recalled to assessment after a subsequent screen remained relatively stable, in the range of 3.2–4.2% (age-standardised).

Analysis of recall rates by age groups in the target age range showed that, in most years, the recall to assessment rate was highest amongst women in the 50–54 years age group. This observation may be due to the fact that women in the younger age group tend to have denser breast tissue which make lesions more difficult to distinguish during screening.⁴ The increase in recall to assessment rates from 1996 to 2016 was similar for all age groups.

For women attending a subsequent screen, higher recall to assessment rates were also observed for the 50–54 years age group, but with little observed change in rates between 1996 and 2015.

International comparison

A comparison can be made with the NHS Breast Screening Programme (NHSBSP) in England, in which women in the age range of 45–70 years are invited to attend a breast screen every three years. In the ten-year period from 2005-06 to 2015-16, the recall to assessment rate for subsequent screens was in the range of 3.9–4.7% in England compared to 3.4–4.1% in Australia (note: non age-standardised data). During this period, the detection rates for invasive, small invasive and all breast cancers in England remained almost unchanged at 8.1–8.2 cases per 1,000.⁵

Recall to assessment and breast cancer control in Australia

Since the introduction of BreastScreen Australia, the age-standardised incidence rate for female breast cancer has increased (from 100.4 per 100,000 in 1991, to 125.0 per 100,000 in 2014, see Cancer incidence). During this period, there has been a decrease in the age-standardised breast cancer mortality rate (from 31.3 per 100,000 in 1991 to 20.1 per 100,000 in 2015 – a 36% reduction – see Cancer mortality) and an increase in 5-year survival rate (from 85.9% in 1995–99 to 92.5% in 2010–2014).⁶

The AIHW has observed that over the last 6-7 years, the increase in the recall to assessment rate led to an increase in detection of invasive breast cancers and ductal carcinoma in situ in women screening for the first time.¹

About the data

This measure shows the proportion of women aged 50–74 years recalled to assessment following screening through BreastScreen Australia, on an annual basis. Data for women aged 50–69 years (previous target age range) are also shown.

Numerator: Number of women in the target age range recalled for assessment following their first screen, or a subsequent screen, in a single year.

Denominator: Number of women in the target age range years receiving a first screen, or a subsequent screen, in that single year.

Methodology

Rates are age-standardised, unless otherwise specified.

Caveat:

Caution should be applied to the international comparison between Australia and England due to the modified age groupings reported by the Health and Social Care Information Centre. Data from the Breast Screening Programme England report for the period 2013-14 and onwards includes women aged 45 and over. Data presented in the charts represent women aged 50-70, except for England in 2015-16 which includes women 45 and over.

Data sources

Australian Institute of Health and Welfare 2018. BreastScreen Australia monitoring report 2018. Cancer series no. 112. Cat. no. CAN 116. Canberra: AIHW
Australian Institute of Health and Welfare 2017. BreastScreen Australia monitoring report 2014–2015. Cancer series no. 106. Cat. no. CAN 105. Canberra: AIHW
Australian Institute of Health and Welfare 2016. BreastScreen Australia monitoring report 2013–2014. Cancer series no. 100. Cat. no. CAN 99. Canberra: AIHW
Australian Institute of Health and Welfare 2015. BreastScreen Australia monitoring report 2012–2013. Cancer series no.95. Cat. no. CAN 93. Canberra: AIHW.
Australian Institute of Health and Welfare 2014. BreastScreen Australia monitoring report 2011–2012. Cancer series no. 86. Cat. no. CAN 83. Canberra: AIHW.
Australian Institute of Health and Welfare 2013. BreastScreen Australia monitoring report 2010–2011. Cancer series no. 77. Cat. no. CAN 74. Canberra: AIHW.
Australian Institute of Health and Welfare 2011. BreastScreen Australia Monitoring Report 2008-2009. Cancer series no. 63. Cat. no. CAN 60. Canberra: AIHW.
Health and Social Care Information Centre 2017. Breast Screening Programme, England 2015-16. Accessed 26 October 2018; http://digital.nhs.uk/data-and-information/publications/statistical/brea...

References

Activity in this area

Data:

Australian Institute of Health and Welfare. AIHW cancer screening publications: Accessed October 2018; https://www.aihw.gov.au/reports-statistics/health-welfare-services/cancer-screening/overview.

Policy:

Commonwealth Department of Health and Ageing. Evaluation of the BreastScreen Australia Program – Evaluation Final Report – June 2009. Screening Monograph No.1/2009. Canberra: Commonwealth of Australia; 2009. Accessed November 2015; http://cancerscreening.gov.au/internet/screening/publishing.nsf/Content/programme-evaluation.

References

1. Australian Institute of Health and Welfare 2017. BreastScreen Australia monitoring report 2014–2015. Cancer series no. 106. Cat. no. CAN 105. Canberra: AIHW.

2. Australian Institute of Health and Welfare 2017. ACIM (Australian Cancer Incidence and Mortality) books. Canberra: AIHW; https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/acim-books

3. Australian Institute of Health and Welfare 2014. BreastScreen Australia monitoring report 2011–2012. Cancer series no. 86. Cat. no. CAN 83. Canberra: AIHW.

4. BreastScreen WA 2012. BreastScreen WA Statistical Report 2006–2010. Perth: Department of Health WA.

5. Health and Social Care Information Centre, England. Accessed November 2017; https://digital.nhs.uk/search?q=breast+screening&s=s

6. Australian Institute of Health and Welfare 2018. BreastScreen Australia monitoring report 2018. Cancer series no. 112. Cat. no. CAN 116. Canberra: AIHW.

Revision Type

Major

Version Number

1.2

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Summary

Just over one in ten women are recalled for further investigation after their initial breast screen

Recall to assessment rates for breast screening have increased since 1996

Data