NEED FOR OPEN ACCESS NON-SCREENING MAMMOGRAPHY IN A HOSPITAL WITH A SPECIALIST BREAST CLINIC SERVICE

Objective - Assessment of open access non-screening mammography in a hospital with a breast clinic. Design - Retrospective analysis of patients sent for first mammogram to our open access service by general practitioners and breast clinic in the year April 1989 to March 1990. Setting - District general hospital serving 200 000 people before the introduction of breast screening. Subjects - 361 symptomatic women referred directly by general practitioners and 226 women referred by the breast clinic for first, non-screening mammograms. Main outcome measures - Radiographic reports on all patients. Final diagnosis in patients reported as having possible or probable neoplasm. Results - Of the women referred directly by general practitioners one (0.2%) was reported as showing probable malignancy (later histologically confirmed) and 15 (4%) as showing possible malignancy (on follow up none had proved malignancy). Of the women referred by the breast clinic 38 (17%) were reported as showing probable malignancy (all had confirmed carcinomas) and 35 (15%) as showing possible malignancy (19 (54%) had proved malignancy). 18 of the proved malignancies were in women under 50 years old, 26 were in women over 64 years, and 14 were in women of screening age. 54 (93%) of the 58 patients with proved breast cancer and an abnormal mammogram had a discrete breast lump. Conclusions - General practitioners accurately divided women into low and high risk groups, resulting in few abnormalities being detected in patients referred directly for mammography. This suggests that an open access non-screening mammography service for general practitioners is unnecessary in an area with a specialist breast clinic. The large proportion of cancers in women outside of screening age emphasises the need for such clinics.