Analysis of Participant Factors That Affect the Diagnostic Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea

Abstract

ObjectiveTo analyze participant factors that affect the diagnostic performance of screening mammography.Materials and MethodsWe enrolled 128756 cases from 10 hospitals between 2005 and 2010. We analyzed recall rate, cancer detection rate (CDR) per 1000 examinations, positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and interval cancer rate (ICR) per 1000 negative examinations according to participant factors including age, breast density, and number of visit to the same institution, and adjusted for confounding variables.ResultsIncreasing age improved recall rates (27.4% in 40's, 17.5% in 50's, 11.1% in 60's, and 8.6% in 70's), CDR (2.7, 3.2, 2.0, and 2.4), PPV (1.0, 1.8, 1.8, and 2.8%), sensitivity (81.3, 88.8, 90.3, and 94.7%), specificity (72.7, 82.7, 89.0, and 91.7%), and FPR (27.3, 17.3, 11.0, and 8.4%) (p < 0.05). Higher breast density impaired recall rates (4.0% in P1, 9.0% in P2, 28.9% in P3, and 27.8% in P4), PPV (3.3, 2.3, 1.2, and 1.3%), specificity (96.1, 91.2, 71.4, and 72.5%), and FPR (3.9, 8.9, 28.6, and 27.6%) (p < 0.001). It also increased CDR (1.3, 2.1, 3.3, and 3.6) and ICR (0.2, 0.3, 0.6, and 1.6) (p < 0.05). Successive visits to the same institution improved recall rates (20.9% for one visit, 10.7% for two visits, 7.7% for more than three visits), PPV (1.6, 2.8, and 2.7%), specificity (79.4, 89.6, and 92.5%), and FPR (20.6, 10.4, and 7.5%) (p < 0.001).ConclusionYoung age and dense breasts negatively affected diagnostic performance in mammography screening, whereas successive visits to the same institution had a positive effect. Examinee education for successive visits to the same institution would improve the diagnostic performance.

Interpretive Performance and Inter-Observer Agreement on Digital Mammography Test Sets

“…In these cases, cancer was not found with either mammography or ultrasonography during follow-up. Mammographically dense breasts constituted 57.3% of the 1000 cases, which was similar to the 54.8% of the Korean population who present with this characteristic (13).…”

Automated Breast Ultrasound Screening for Dense Breasts

“…The frequency of dense breasts in the screening population over the age of 40 years was 43.3% in the United States and 54.8% in Korea. Moreover, among young women in their 40s, it increased to 56% and 83.2%, respectively (11,12). Korean…”

Age of Data in Contemporary Research Articles Published in Representative General Radiology Journals

“…In total, 50 KJR (9101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354565758), 492 ER, and 254 Radiology articles reported original research studies analyzing patient data. Of these, 44 (88%; 95% CI: 75.8–94.8%) (910121314151617181920212324262728293031323435363738394041424344474849505152535455565758), 359 (73%; 95% CI: 68.9–76.7%), and 211 (83.1%; 95% CI: 78–87.2%) articles, respectively, revealed the start and end of data collection to the level of calendar month.…”

“…Of these, 44 (88%; 95% CI: 75.8–94.8%) (910121314151617181920212324262728293031323435363738394041424344474849505152535455565758), 359 (73%; 95% CI: 68.9–76.7%), and 211 (83.1%; 95% CI: 78–87.2%) articles, respectively, revealed the start and end of data collection to the level of calendar month. The point estimate value of this proportion was slightly larger in KJR than in ER and Radiology, although the difference was not statistically significant.…”