LAUSR

Ravaioli et al. are correct – our survey question regarding which performance measures were included in the audit feedback was a fixed-response type, and we agree that in any future survey, early rescreen rate should be added as a response option. Although early rescreen is not recommended in the European guidelines for breast cancer screening and diagnosis, it is known that European women undergo short-term follow-up, generally further mammography or additional imaging, after either suspicious findings on screening mammograms, or a non-conclusive assessment. In the United States, radiologists use the classification ‘‘BI-RADS 3’’ when assessing specific image findings known to have a small (0–42%) likelihood of representing malignancy. Although these findings are not expected to change over time, this classification recommends shortinterval follow-up, with repeat imaging, usually at six months, and regularly thereafter, until the finding is known to be stable (usually at two years). This approach helps to avoid unnecessary biopsies, but if changes occur, it allows for early diagnosis. Early rescreen may cause anxiety and fear comparable with the effect of a false positive screening test, or it may reassure women that they are being better cared for, because the extra screening/assessment will either rule out breast cancer, or detect it early. The sensitivity and specificity of early rescreen will depend on the triggering assessment. Studies are needed to test these assumptions, and to improve understanding of this issue. Estimates and reports of sensitivity and specificity for rescreens should be available for both the reader and the facility. Evidence and consensus on the pro and cons of all aspects of rescreening are needed to establish quality assurance parameters for this rescreening.