In breast cancer screening, the abnormal call rate (ACR) is the percentage of mammograms that are identified as abnormal and require additional testing. If the ACR is too low, some cancers will not be detected. If it is too high, people who might not have cancer will be asked to take unnecessary follow-up tests.
The ideal ACR finds the right balance. But in Canada, ACRs are increasing while cancer detection rates stay the same. That means more people are being told that their mammogram result is abnormal, when in fact this is not the case.
The Canadian breast screening community, with the support of the Partnership, has developed a framework for achieving optimal ACRs. Putting it into action will help maintain the benefits of screening programs while reducing harms to patients and costs to the healthcare system.
This framework was developed to ensure those screened for breast cancer benefit from high-quality, standardized breast screening practices and unnecessary encounters with the health system are avoided. With COVID-19 placing new demands on Canada’s health system, it is critical that we reduce the use of healthcare resources while maintaining the quality of care.
-Dr. Nancy Wadden, Vice President, Canadian Society of Breast Imaging; Working Group Chair, Mammography Accreditation Program, Canadian Association of Radiologists.
What is in the framework
There are many practical ways to optimize ACRs. The Pan-Canadian framework for action to address abnormal call rates in breast cancer screening suggests six evidence-informed approaches.
- Peer review, mentorship and education to help improve radiologist performance
- Standardized report cards that outline key next steps and goals for improvement
- Minimum reading volumes to give radiologists more experience and expertise
- Batch reading so radiologists can focus on and interpret mammograms without interruption
- Double reading so that two readers interpret any given mammogram
By strengthening or introducing these approaches into their programs, the screening community can support the achievement of optimal ACRs. In turn, that will help maximize the benefits of breast cancer screening for Canadians.
The goals of the framework
The six approaches in the framework apply at the practitioner, program and system levels and are informed by evidence reviews from the Centre for Effective Practice and Research Sciences International. The overall goals of the framework are to:
- Accelerate the uptake of the best available, evidence-based clinical practices
- Support the implementation of approaches for improving the quality of breast cancer screening
- Maximize the benefits and minimize the harms of screening and diagnostic assessments
- Help track, meet and refine Canada’s national ACR targets
Who the framework is for
The intended users of the framework include:
- Health system administrators, including screening program leads and diagnostic imaging section leads
- Healthcare professionals, including radiologists and mammogram technologists
- Researchers and specialists working in breast cancer screening
- Policy specialists and decision makers responsible for making sure quality-improvement initiatives have the resources they need
The framework serves as a guide to help them identify and tailor strategies based on their own needs and priorities.
How the framework supports the Strategy
The framework directly supports the Canadian Strategy for Cancer Control. Released in 2019, the Strategy calls on cancer system stakeholders and partners to improve equity and deliver quality care in a sustainable way. Diagnosing cancer faster, earlier and accurately is one of the eight priorities of the Strategy.
As Canada responds to the COVID-19 pandemic, we need now, more than ever, to address gaps and generate efficiencies in the cancer system. Our country’s high ACRs in breast cancer screening is an area we can address — and this Framework provides key players in the health system with the guidance to do so.
–Gregory Doyle, Chair, Canadian Breast Cancer Screening Network