International Variation in Screening Mammography Interpretations in Community-Based Programs

Elmore, Joann G.; Nakano, Connie; Desnick, Laurel; D’Orsi, Carl J.; Ransohoff, David F.

doi:10.1093/jnci/djg048

Cited by 160 publications

(124 citation statements)

References 84 publications

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“…Whether using crude cancer incidence or age standardized incidence, cancer incidence rates are similar for the US (130/100,000 crude, 90/100,000 standardized) and the Netherlands (136/100,000 and 92/100,000), though they are at opposite ends of the scale for recall rates (US 15.1%, the Netherlands 1.4%). 11 The number of cancers may be too small to draw any conclusion. Further evaluation with more years of data would be useful.…”

Section: Discussionmentioning

confidence: 99%

“…This information has been previously published. 10,11,[24][25][26] Phase I An assessment form that requested information specific to how mammograms were read and interpreted was distributed to IBSN country representatives by e-mail in autumn 1999. The following specific data on factors that may affect screening outcomes were also requested: number of facilities in the program, number of radiologists, whether mammograms are double-read and how differing assessments are resolved, use of one-or two-view mammography, use of clinical breast examination in conjunction with screening mammography, categories used for recording breast density, and whether program data include women with a history of breast cancer, breast biopsy, or surgery.…”

Section: Study Groupmentioning

confidence: 99%

“…[10][11][12] Published rates range from 1.4% for the initial and 0.7% for subsequent mammograms in the Netherlands 13 to 13.8% for the initial and 8.6% for subsequent screening mammograms in Canada.…”

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confidence: 99%

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International comparison of performance measures for screening mammography: can it be done?

Yankaskas

Ancelle-Park

et al. 2004

J Med Screen

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Objective: Published screening mammography performance measures vary across countries. An international study was undertaken to assess the comparability of two performance measures: the recall rate and positive predictive value (PPV). These measures were selected because they do not require identification of all cancers in the screening population, which is not always possible. Setting:The screening mammography programs or data registries in 25 member countries of the International Breast Cancer Screening Network (IBSN). Methods:In 1999 an assessment form was distributed to IBSN country representatives in order to obtain information on how screening mammography was performed and what specific data related to recall rates and PPV were collected. Participating countries were then asked to provide data to allow calculation of recall rates, PPV and cancer detection rates for screening mammography by age group for women screened in the period 1997-1999.Results: Twenty-two countries completed the assessment form and 14 countries provided performance data. Differences in screening mammography delivery and data collection were evident. For most countries, recall rates were higher for initial than for subsequent mammograms. There was no consistent relationship of initial to subsequent PPV, although PPV generally decreased as the recall rate increased. Recall rates decreased with increasing age, while PPV increased as age increased. Conclusion:Similar patterns for mammography performance measures were evident across countries.However, the development of a more standardized approach to defining and collecting data would allow more valid international comparisons, with the potential to optimize mammography performance. At present, international comparisons of performance should be made with caution due to differences in defining and collecting mammography data.

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Section: Discussionmentioning

confidence: 99%

Section: Study Groupmentioning

confidence: 99%

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International comparison of performance measures for screening mammography: can it be done?

Yankaskas

Ancelle-Park

et al. 2004

J Med Screen

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“…Radiologists in the United States have higher recall rates and false-positive rates compared with radiologists from other countries. 13,14 It is also possible that radiologists do not use pretest probability to influence the decision making process when interpreting screening mammograms. Due to time constraints or perhaps due, in part, to the isolation from patients when interpreting screening mammography examinations (batch reading), radiologists may not view mammographic films in the context of a specific woman.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Thus it is reasonable to ask if heightened perception of risk exists among US radiologists, and whether this heightened perception is associated with higher recall rates among radiologists. In this study, we describe radiologists' perception of breast cancer risk at the level of an individual woman.…”

Section: Conclusion-us Radiologists Have a Heightened Perception Ofmentioning

confidence: 99%

Mammographers’ Perception of Women’s Breast Cancer Risk

et al. 2005

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Objective-To understand mammographers' perception of individual women's breast cancer risk.Materials and Methods-Radiologists interpreting screening mammography examinations completed a mailed survey consisting of questions pertaining to demographic and clinical practice characteristics, as well as 2 vignettes describing different risk profiles of women. Respondents were asked to estimate the probability of a breast cancer diagnosis in the next 5 years for each vignette. Vignette responses were plotted against mean recall rates in actual clinical practice.Results-The survey was returned by 77% of eligible radiologists. Ninety-three percent of radiologists overestimated risk in the vignette involving a 70-year-old woman; 96% overestimated risk in the vignette involving a 41-year-old woman. Radiologists who more accurately estimated breast cancer risk were younger, worked full-time, were affiliated with an academic medical center, had fellowship training, had fewer than 10 years experience interpreting mammograms, and worked more than 40% of the time in breast imaging. However, only age was statistically significant. No association was found between radiologists' risk estimate and their recall rate. Conclusion-U.S. radiologists have a heightened perception of breast cancer risk.Keywords perception; risk; pretest probability Clinicians routinely use information about patient risk when making medical decisions. [1][2][3][4] This risk assessment is based on their understanding of disease prevalence and the impact of patient history. Bayes' theorem, used intuitively by many clinicians, utilizes sensitivity, specificity, and pretest probability to determine the positive predictive value that a patient has a particular disease given a positive test for that disease. 5,6 As a result, a clinician's 12 This statistic may be somewhat misleading, however, as it is not an estimate for a short time interval (1-5 years) but a lifetime risk, and it is a risk of a diagnosis, not a death.US radiologists have a higher recall rate than do their counterparts in other countries. 13,14 Thus it is reasonable to ask if heightened perception of risk exists among US radiologists, and whether this heightened perception is associated with higher recall rates among radiologists. In this study, we describe radiologists' perception of breast cancer risk at the level of an individual woman. We then use a unique link with actual clinical practice in the community to see if perception of breast cancer risk is associated with recall rate (the percentage of screening mammograms interpreted as abnormal and requiring additional evaluation). METHODS Study PopulationThis community-based, multicenter observational study utilizes a unique collaboration among 3 geographically and clinically distinct breast cancer screening programs: a nonprofit health plan in the Pacific Northwest, Group Health Cooperative Breast Cancer Surveillance System; 15,16 the New Hampshire Mammography Network, 17 which captures >85% of women having mammography in the state...

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Screening for Breast Cancer

Elmore

Armstrong

Lehman

et al. 2005

JAMA

785

498

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REAST CANCER SCREENING, ESpecially with mammography, has been recommended for many decades, 1 and the majority of women older than 40 years in the United States participate in screening activities. 2,3 Meanwhile, new screening modalities have been introduced, and some of these have been increasingly incorporated into community practice. However, none of the new technologies has been evaluated for its effect on breast cancer mortality. Community practice of screening may differ from the care provided within randomized clinical trials and is less often discussed in review articles. Reviews of breast cancer screening usually emphasize efficacy and results of randomized trials, particularly those involving screen-film mammography. 4-7 Efficacy of a screening tool is measured in experimental studies under ideal circumstances. 8 In contrast, effectiveness is defined as the extent to which a specific intervention "when deployed in the field in routine circumstances, does what it is intended to do for a specific population." 8 We systematically reviewed what is known about the community practice of mammography, clinical breast examination, and breast self-examination, when possible, comparing the results from community studies with CME available online at www.jama.com

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International Variation in Screening Mammography Interpretations in Community-Based Programs

Abstract: North American screening programs appear to interpret a higher percentage of mammograms as abnormal than programs from other countries without evident benefit in the yield of cancers detected per 1000 screens, although an increase in DCIS detection was noted.

Cited by 160 publications

References 84 publications

International comparison of performance measures for screening mammography: can it be done?

International comparison of performance measures for screening mammography: can it be done?

Mammographers’ Perception of Women’s Breast Cancer Risk

Screening for Breast Cancer

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