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Our protocol for assessment of women with screen-detected malignancy was changed to include bilateral whole breast and axillary ultrasound (BBUS) following a prospective study that confirmed the benefit of this in 2002 . This audit assesses the impact of introducing this change.
Biopsy results for all women with screen-detected cancer diagnosed between April 2003 and March 2009 were reviewed to identify cases where multiple biopsies had been performed. The reason for additional biopsy and subsequent management were recorded. The data were compared with control data (2001) obtained prior to the introduction of the protocol, and with national outcome data for screen-detected cancer.
A total of 199,307 women were screened during the audit period, and 1,700 women were diagnosed with breast cancer. Table Table11 demonstrates the findings for women diagnosed with cancer who had additional biopsies, compared with the control population. Data for 2008/09 show that this unit has a repeat operation rate of 18% for non-invasive disease and 16% for invasive disease compared with national averages of 28% for non-invasive and 23% for invasive cancer .
Additional cancers and axillary node metastases were detected as a result of introducing a policy of proactive assessment of disease extent. The unit has a favourable rate of re-operations compared with national data.