Year one of the Irish 'mammogram only pathway': A prospective single centre evaluation

Referral numbers from symptomatic breast clinics in Ireland continue to increase. In April 2021, a new symptomatic referral guideline was launched. This included a 'Mammogram Only' stream that enabled women over age 35 with mastalgia and a normal clinical assessment in primary care to proceed to mammography, obviating the need for a clinic visit. This study evaluates the outcomes of the first year of implementation of the 'Mammogram Only' pathway. All women, aged over 35, referred to St Vincent's University Hospital and triaged to the new 'Mammogram Only' pathway from 01/04/2021 to 31/03/2022 were identified for audit. Outcomes assessed were rate of cancer diagnosis, rate of recall for further imaging assessment and rate of biopsy. The comparative cohort were non-urgent referrals (>35yrs) triaged to our 'Image 1st Pathway' (mammography followed by subsequent clinic visit). A total of 1091 women (median age 52) were assigned to the 'Mammogram Only' pathway and attended for mammography. 7% of patients were recalled for further evaluation with 3% of the overall cohort undergoing a biopsy. Just under 2% of patients (1.6%) were diagnosed with breast cancer. Of the 2079 patients during the same time frame who were evaluated through the 'Image 1st Pathway' the corresponding figures were: recall rate 12%, biopsy 6%, cancer 2.6%. This initial experience of the 'Mammogram Only' pathway confirms the ability of primary care to stratify patients with normal clinical assessment and mastalgia only for mammography with low rates of recall and biopsy and a cancer detection rate of <2%.