Recall to assessment

Published

08 Jan, 2020

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 females are recalled for further investigation after their initial breast screenIn 2017, 11.3% of females in the target age range of 50–74 years were recalled for further investigation (assessment) after their first breast screen.  

Recall to assessment rates after initial screening have increased since 1996Among females in the age range of 50–69 years, recall to assessment rates after a first screen increased from 5.8% in 1996 to 12.2% in 2014, although have since decreased to 11.2% (2016 and 2017). The increase since 1996 correlates with an increase in the detection rate of invasive breast cancers.

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Notes

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

Proportion of females in target age range recalled for assessment following a breast screen, 1996 to 2017
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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 2017
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Notes

• Data source for England is from the NHS Breast Screening Programme (NHS BSP) 2017-18 Report.
• England data are for women aged 45 and over. 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 females by Australian cancer registries. It is projected that in 2019, 19,535 females and 164 males will be diagnosed with this disease, and that it will remain the fourth 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 43.²

Breast screening aims to detect breast cancers in asymptomatic females, 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 females are more likely to be recalled to assessment after their first breast screen than after subsequent screens.¹

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 females aged 50–69 years, but the Federal Budget in 2013-14 allowed for extension of the BreastScreen Australia program from July 2013 to include females 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 2017, 11.3% of females aged 50–74 years were recalled for further investigation (assessment) after their first breast screen (age-standardised data). For females aged 50–74 years who were attending a second or later (subsequent) screen, 3.6% were recalled for assessment.¹

The recall to assessment rate was similar across the different age groups in the target age range for both first and subsequent breast screens.¹

Trends

Trend data are available for females aged 50–69 years from 1996, and for females aged 50–74 years from 2015. From 1996 to 2017, 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 12.2% in 2014, and has since decreased to 11.2% in 2017 (age-standardised data).^1,3Similarly, among females aged 50–74 years the proportion recalled to assessment after the first breast screen decreased slightly from 11.8% in 2015 to 11.2% in 2017.^1,3

From 1996 to 2015, the proportion of females 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).^1,3 Similarly, from 2015 onwards the proportion of females aged 50–74 years recalled to assessment after a subsequent screen varied between 3.5-3.8%.^1,3

Analysis of recall rates by age groups in the target age range showed that the increase in recall to assessment rates from 1996 to 2017 was similar for most age groups. Since 2015, recall rates have been lowest among females age 60–64 years and highest among females aged 70–74 years.¹

For females attending a subsequent screen, higher recall to assessment rates have been consistently observed for the 50–54 years age group; this observation may be due to the fact that females in the younger age group tend to have denser breast tissue which make lesions more difficult to distinguish during screening.^1,5. There has been little observed change in subsequent screen rates between 1996 and 2017.¹

International comparison

A comparison can be made between recall to assessment data for BreastScreen Australia and the NHS Breast Screening Programme (NHSBSP) in England. In the ten-year period from 2006-07 to 2016-17, the recall to assessment rate for females aged 45 and over in the NHSBSP remained relatively stable after the first and subsequent breast screens. The recall to assessment rate after the first breast screen was in the range of 7.7-8.5% in England compared to 9.8-11.2% in Australia. For subsequent screens, the recall to assessment rate was in the range of 3.2-3.3% in England compared to 3.5-4.0% 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 8.0 cases per 1,000.⁶

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 124.4 per 100,000 in 2015, 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 19.9 per 100,000 in 2016, see Cancer mortality) and an increase in 5-year survival rate (from 85.9% in 1995-1999 to 90.8% in 2011–2015).^2,3

The AIHW has observed that over time, the proportion of women attending a breast screening for the first time who were recalled to assessment has increased.¹ The increase in the recall to assessment rate has led to an increase in detection of invasive breast cancers and ductal carcinoma in situ in females screening for the first time.¹

About the data

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

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

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

Data sources:

Australian Institute of Health and Welfare. AIHW Breast cancer screening publications : Accessed December 2019; https://www.aihw.gov.au/reports-data/health-welfare-services/cancer-screening/reports

Australian Institute of Health and Welfare 2019. BreastScreen Australia monitoring report 2019. Cancer series no. 127. Cat. no. CAN 128. Canberra: AIHW. Canberra: AIHW.
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; https://digital.nhs.uk/data-and-information/publications/statistical/breast-screening-programme/breast-screening-programme-england-2015-16

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 females aged 45 and over. Data presented in the charts represent females aged 50-70, except for subsequent screening rates (England only) in 2016-17 which includes females 45 and over.

References

Activity in this area

Data:

Australian Institute of Health and Welfare. AIHW cancer screening publications: AccessedDecember 2019 https://www.aihw.gov.au/reports-data/health-welfare-services/cancer-screening/reports

Policy:

Commonwealth Department of Health. BreastScreen Australia, Policy. Accessed December 2019; http://cancerscreening.gov.au/internet/screening/publishing.nsf/Content/policy:

References

1. Australian Institute of Health and Welfare 2019. BreastScreen Australia monitoring report 2019. Cancer series no. 127. Cat. no. CAN 128. Canberra: AIHW. Canberra: AIHW.

2. Australian Institute of Health and Welfare 2019. Cancer in Australia 2019. Cancer series no.119. Cat. no. CAN 122.

3. Australian Institute of Health and Welfare 2019. ACIM (Australian Cancer Incidence and Mortality) books. Canberra: AIHW; https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/acim-books

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

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

6. NHS Digital 2019. Breast screening programme, England 2017-18. Accessed October 2019;

https://digital.nhs.uk/data-and-information/publications/statistical/breast-screening-programme

Revision Type

Major

Version Number

1.2

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Summary

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

Recall to assessment rates after initial screening have increased since 1996

Data