Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors

Abstract

Objective To assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics. Study Design and Setting Screening mammograms (n=638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries were linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression. Results Having one or more clinical risk factors was associated with higher recall rates [1 vs. 0 risk factors: odds ratio=1.17, 95% confidence interval=(1.15-1.19); ≥2 vs. 0: 1.43(1.40-1.47)] and lower specificity [1 vs. 0: 0.86(0.84-0.88); ≥2 vs. 0: 0.70(0.68-0.72)] without a corresponding improvement in sensitivity and only a small increase in positive predictive value [1 vs. 0: 1.08(0.99-1.19); ≥2 vs. 0: 1.12(0.99-1.26)]. There was no indication that influence of risk factors varied by radiologist characteristics. Conclusion Women with clinical risk factors who undergo screening mammography are more likely recalled for false positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.

Cumulative Probability of False-Positive Recall or Biopsy Recommendation After 10 Years of Screening Mammography

“…Positive associations between FP recall and previous breast biopsies, family history of breast cancer, postmenopausal hormone therapy use, more recent exam year, and time between screening exams have been reported previously, as have negative associations between FP recall and older age and comparison film availability (6,15,18,(27)(28)(29). We also identified statistically significant associations between FP recall and family history of breast cancer, exam year, time since previous mammogram, and availability of comparison films.…”

The Influence of Mammographic Technologists on Radiologists' Ability to Interpret Screening Mammograms in Community Practice

“…Interpretive performance of screening mammography is known to vary by patient (4, 23–25), radiologist (4–7, 9, 11, 24–30) , and facility level characteristics. (30, 31) However, the extent to which screening mammography performance varies by the radiologic technologist has yet to be investigated.…”

“…(4, 23, 24) Radiologist level factors found to affect performance include time since graduation from residency, breast-imaging fellowship/training, annual interpretative volume, years of mammographic imaging and interpretation, and primary affiliation with an academic medical center. (4–7, 9, 24–26, 28–30) Facility level characteristics that may affect performance include volume, screening versus diagnostic mammography mix, having breast imaging specialists interpreting the examinations, and having audits two or more times per year. (30, 31) Despite numerous studies examining the patient, radiologist, and facility characteristics, variation in performance measures still exist and perhaps it is due to the radiologic technologist obtaining the image.…”

Breast density: the trend in breast cancer screening

“…A number of studies have shown that mammography sensitivity is lower in dense breasts compared to fatty breasts [9][10][11][12][13][14][15][16][17][18][19]. Cook et al [17] reported that the sensitivity of mammography for women with extremely dense breasts was as low as 29 %, whereas recall rates among them increased by 17 % compared to in scattered fibroglandular dense breasts. To compensate for decreased performance of mammography in women with denser breasts, several studies using complemental imaging modalities have been reported.…”