Assessing the Factors Leading to Missed Breast Cancer Diagnoses in Mammography Among Pakistani Women: A Prospective Cross-Sectional Study

Objective To determine the frequency of false-negative mammograms, and identify the factors contributing to missed breast cancer diagnoses in Pakistani women. Materials and methods This descriptive, prospective cross-sectional study was conducted at a tertiary care hospital from December 15, 2020, to December 10, 2023, including 150 women aged 30 to 60 who underwent bilateral mammography and concurrent breast ultrasound. The study analyzed the frequency and causes of false negatives, categorizing them into patient-related, tumor-related, technical-related, and provider-related factors. Stratification was performed based on age groups and Breast Imaging Reporting and Data System (BI-RADS) scores, and statistical significance was assessed using Chi-square tests. Results The study found a 5.1% frequency of false-negative mammograms. Lesion-related factors were seen in 59 (39.7%) patients; patient-related factors were seen in 40 (26.7%) patients; provider-related factors were seen in 29 (19.3%) patients; and technical-related factors were seen in 22 (26.7%) patients. Conclusion Dense breast tissue significantly contributes to missed breast cancer diagnoses in Pakistani women. While lesion-related, provider-related, and technical-related factors uniformly affect mammography outcomes, addressing patient-specific challenges - particularly in younger women with dense breasts - is crucial. The study suggests incorporating supplementary imaging modalities, like ultrasound, in routine screening for better detection, potentially informing national breast cancer screening guidelines in Pakistan.