Abstract
Mammography is used frequently for the diagnosis of breast cancer. In Fukuyama city, we formulated a new diagnostic system for primary screening of the general public in 2007. Inspection and palpation combined with mammography have been performed for all women screenees, double reading has been performed, with the second reading performed by physicians who are certified as Grade A by the Central Committee for Quality Control of Mammographic Screening in Japan, and if the diagnostic results differ, a third reading has been performed. This system has led to a very satisfactory level of diagnostic accuracy, with a recall rate of 7.7%, a cancer detection rate of 0.43%, and a positive predictive value (PPV) of 6.0%. The rate of early cancer detection is 85.7%, andtherateof DCIS is 21.4%. However, for women in their 40s, there has been no improvement in the recall rate (10.3%) or cancer detection rate (0.25%). Quality control of screening with inspection and palpation also revealed a seriously high false negativity rate (76.2%), and the cancer detection rate without mammography was very low (0.02%). Although our new diagnostic system for breast cancer screening has proved very effective, problems associated with the screening of young women and cost-effectiveness remain to be solved.
