[Breast complaints during the Dutch nationwide breast cancer screening program: increased risk of referral and of breast cancer].
OBJECTIVE: To determine the prevalence of breast complaints reported on a questionnaire among participants in the first round of the national breast cancer screening programme in the Netherlands, and to assess the relationship between these complaints and referral and diagnosis of breast cancer. DESIGN: Retrospective controlled study. METHOD: Women in the South screening region of the Dutch nation-wide breast cancer screening programme (Stichting Bevolkingsonderzoek Borstkander Zuid (BoBZ)) received a medical questionnaire together with the invitation for participation in the screening programme. This questionnaire was only reviewed by the radiologist if there were doubts concerning referral. The study assessed whether participants with these complaints had higher risks of referral and screen-detected breast cancer than those without these complaints. In this study two random and independent samples were drawn from the screening files: 1116 women who attended the first screening round and 1113 women who were referred for medical checkup in the same screening round. RESULTS: The prevalence of breast complaints reported in the first screening round was 5.1% (95% CI = 3.9-6.6). More than half of the complaints included pain not related to menses; nipple secretion; changes in skin (retraction or discolouration) or tumours. The referral risk for women with these complaints was more than twice that for women without complaints (adjusted odds ratio (OR) = 2.3; 95% CI = 1.4-3.8) and their risk of screen-detected breast cancer was more than three times as high (adjusted OR = 3.3; 95% CI = 1.4-3.8). Up to 5.8% of the screen-detected breast cancers could be attributed to the breast complaints. CONCLUSION: Breast complaints at the time of breast cancer screening increased the risk of breast cancer being detected, but it is not clear as yet whether the screening will benefit from the explicit incorporation of questions regarding complaints.