NHSBSP guidelines recommend that symptoms or signs reported at the time of mammographic screening should be evaluated by the film reader and the woman should be recalled for further assessment if appropriate. The aim of this audit was to document the clinical features most likely to be associated with cancer and to clarify our guidelines for symptomatic recall. We identified 1,075 women with normal screening mammograms who had breast symptoms or signs recorded at screening and were subsequently recalled for assessment between April 1991 and July 2004.
The results showed that cancer was found in 13/1,075 women. Of these, nine women had a lump (invasive cancers), two women had a skin dimple (invasive cancers), one woman had an eczematous nipple change (Paget's disease) and one woman had a bloody nipple discharge (DCIS). Our audit shows that the majority of symptomatic recalls did not have cancer (1,062/1,075), and no cancers were detected in women with thickening, nodularity, lumpiness, breast pain/odd sensations or nonblood-stained nipple discharge. More significant symptoms, which in some cases proved to be indicative of an underlying cancer, were a lump in the breast or axilla, a skin dimple, an eczematous/weeping nipple, a bloody nipple discharge and nipple inversion.