Influence of false-positive mammography results on subsequent screening: do physician recommendations buffer negative effects?

DeFrank, Joseph; Rimer, Barbara K.; Bowling, J. Michael; Earp, Jo Anne; Breslau, Erica S.; Brewer, Noel T.

doi:10.1258/jms.2012.011123

Cited by 31 publications

(20 citation statements)

References 37 publications

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“…Some women who undergo screening mammography may regard the small increase in the FPR as an acceptable trade-off for improved sensitivity (28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Buist¹,

Anderson²,

Smith³

et al. 2014

Radiology

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Purpose:To examine radiologists' screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists. Materials andMethods:In an institutional review board-approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [FPR], and cancer detection rate [CDR]). Logistic regression was used to assess the association between the volume of recalled screening mammograms ("own" mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and "any" mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up. Results:Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% performed the work-up for 0-50, and 39% performed the work-up for more than 50. For the work-up of recalled screening mammograms from any radiologist, 24% of radiologists performed the work-up for 0-50 mammograms, 32% performed the work-up for 51-125, and 44% performed the work-up for more than 125. With increasing numbers of radiologist workups for their own recalled mammograms, the sensitivity (P = .039), FPR (P = .004), and CDR (P , .001) of screening mammography increased, yielding a stepped increase in women recalled per cancer detected from 17.4 for 25 or fewer mammograms to 24.6 for more than 50 mammograms. Increases in work-ups for any radiologist yielded significant increases in FPR (P = .011) and CDR (P = .001) and a nonsignificant increase in sensitivity (P = .15). Radiologists with a lower annual volume of any work-ups had consistently lower FPR, sensitivity, and CDR at all annual interpretive volumes. Conclusion:These findings support the hypothesis that radiologists may improve their screening performance by performing the diagnostic work-up for their own recalled screening mammograms and directly receiving feedback afforded by means of the outcomes associated with their initial decision to recall. Arranging for radiologists to work up a minimum number of their own recalled cases could improve screening performance but would need systems to facilitate this workflow.q RSNA, 2014

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“…Some women who undergo screening mammography may regard the small increase in the FPR as an acceptable trade-off for improved sensitivity (28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Buist¹,

Anderson²,

Smith³

et al. 2014

Radiology

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“…9,10,25,26 Our hypothesis was framed by the Transactional Model of Stress and Coping 27–29 that offers a possible explanation as to how the stress of a positive FIT results may upset an individual’s psychological well-being such that poor coping efforts drive them toward healthcare utilization in order to restore balance.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesized that, similar to other positive cancer screening tests, some patients may increase their healthcare utilization behavior (e.g. seeking additional outpatient services 9,25,26 ). Our hypothesis is based on The Transactional Model of Stress and Coping, 27–29 a theoretical framework that conceptualizes stressful experiences and coping as transactions between the patient and the environment.…”

Section: Introductionmentioning

confidence: 99%

Primary care visit use after positive fecal immunochemical test for colorectal cancer screening

Hillyer

Jensen

Zhao

et al. 2017

Cancer

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Background For some patients, positive cancer screening test results can be a stressful experience which can affect future screening compliance and increase the utilization of healthcare services unrelated to medically-indicated follow-up. Methods Among 483,216 individuals, aged 50–75 years, who completed a fecal immunochemical test to screen for colorectal cancer at a large integrated health care setting between 2007 and 2011, we evaluated whether a positive test was associated with a net change in outpatient primary care visit use in the year following screening. We used multivariable regression models to evaluate the relationship between test result group and net changes in primary care visits following fecal immunochemical test. Results In the year following the fecal immunochemical test, utilization increased by 0.60 clinic visits for true positives. The absolute change in visits was largest (3.00) among test positive patients diagnosed with colorectal cancer but significant small increases were also found for polypectomy/no neoplasia (0.36) and normal exam/no polypectomy (0.17). Groups that demonstrated an increase in net visit use compared to the true negative group included true positives (OR 1.60, 95% CI 1.54–1.66), and positive groups with colorectal cancer diagnosis (OR 7.19, 95%CI 6.12–8.44), polypectomy/no neoplasia (OR 1.37, 95%CI 1.27–1.48) and normal exam/no polypectomy groups (OR 1.24, 95%CI 1.18–1.30). Conclusion Given the large size of outreach programs, these small changes can cumulatively generate thousands of excess visits and have substantial impacts on total health care utilization and thus should be included in colorectal cancer screening cost models and their causes investigated further.

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“…8,9 Falsepositive rate refers to recalls for further assessment which turn out to be normal or benign. 10 This is one of the reasons for the ongoing screening debate, since it gives rise to negative effects, namely: financial costs to the health service and psychological strain on the women. 10,11 Since the majority of screening mammograms are normal, radiologists' record of reporting should demonstrate high specificity avoiding false-positive mammograms.…”

Section: Quality Assurance (Qa)mentioning

confidence: 99%

“…10 This is one of the reasons for the ongoing screening debate, since it gives rise to negative effects, namely: financial costs to the health service and psychological strain on the women. 10,11 Since the majority of screening mammograms are normal, radiologists' record of reporting should demonstrate high specificity avoiding false-positive mammograms. 12 In addition to false positive rates, several other performance parameters were identified by 'The European Guidelines for QA in Breast Cancer Screening and Diagnosis'.…”

mentioning

confidence: 99%

A retrospective audit of the first screening round of the Maltese breast screening programme

2017

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Purpose: To analyse whether the screening performance parameters of the Maltese National Breast Screening Programme first screening round met requirements set by European standards. The association between screening age and results of screening performance parameters was also investigated. Method:Quantitative methodology was used to review examinations of women who were recalled for a technical recall or further assessment rates. All accessible members of the population recalled during the first round were retrospectively reviewed resulting in a sample of 2300 recalled examinations.Results: Malta's first screening round met the European Guidelines recommendations for technical repeat rate (0.26%), early recall rate (0.45%), breast cancer detection rate (13.77 per 1000 women) and Positive Predictive Value of screening test (7.58%). However, local recall rate (18.53%) and further assessment rate (18.27%) were higher than recommended.The Chi square test showed a statistically significant difference (p<0.05) in recall rates between the compared age groups, as younger women (51-55 years) were more likely to have a negative diagnosis after the initial mammogram whereas older women (56-60 years) were more likely to be recalled. There was no age discrepancy (p>0.05) in local breast cancer detection rate and positive predictive value of screening test. Conclusion:Although the Maltese first screening round performed well, this study found deficiencies in recall and further assessment rates, which according to literature may result in psychological morbidity and inefficient use of screening resources. This study also concluded that when a cohort is analysed, age is not as significant as the screening round itself (first/subsequent). KeywordsBreast cancer, breast screening programme, screening performance parameter, false positive mammogram, age effect IntroductionBreast cancer is the most common cancer among Maltese women and accounts for a third of all female cancer deaths. Every one in twelve Maltese women will get breast cancer in her lifetime; a significantly higher proportion than the European average. 1 In October 2009, Malta's Department for Health agreed to implement a National Breast Screening Programme (MNBSP). 2 The aim of screening was to reduce morbidity and mortality from the disease without adversely affecting the health of participants. 3,4 Key to achieving this aim were high levels of quality within the entire screening process. 4 The MNBSP strives to protect the dignity and privacy of women, while offering an effective service at the highest levels of quality to diagnose and treat breast cancers at the earliest possible stage, and also meeting the European clinical standards. 4 The first MNBSP round commenced in October 2009 and ended in February 2013. The local screening programme provided free screening, every three years for all women aged 50 to 60, resident in the Maltese Islands. This age range was selected for the first screening round since this age group was deemed to be the 'most at risk'...

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Influence of false-positive mammography results on subsequent screening: do physician recommendations buffer negative effects?

Cited by 31 publications

References 37 publications

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

Primary care visit use after positive fecal immunochemical test for colorectal cancer screening

A retrospective audit of the first screening round of the Maltese breast screening programme

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