Mammographers’ Perception of Women’s Breast Cancer Risk

Abstract

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...

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

“…Indeed, in one study of these same radiologists, 96% overestimated an individual woman's 5- year risk of a diagnosis of breast cancer, particularly those with risk factors such as family history of breast cancer and prior biopsy (15). This suggests that radiologists may be over influenced by some risk factors when they are deciding whether or not to recall women for additional work up or are considering whether or not to biopsy a possible abnormality.…”

“…While observational studies have shown that mammography performed on women currently using postmenopausal hormone therapy (HT) have higher false positive rates (8, 15-18) and lower sensitivity (8, 18) it is not clear if this is completely caused by HT's effect on breast density or if radiologists are being influenced by the knowledge of HT use, or both. In our study, we adjusted our analyses for radiologists' interpretation of breast density.…”

Recommendation for Short-Interval Follow-Up Examinations After a Probably Benign Assessment: Is Clinical Practice Consistent With BI-RADS Guidance?

“…It is important to note that few of the 15,515 probably benign assessments were given to women with extremely dense breasts ( n = 1,005) or with symptoms ( n = 266 with a breast lump and n = 893 with other symptoms). Radiologists may have recommended these women for immediate follow-up because they doubted the accuracy of mammography in women with dense breasts [19, 20] or because they considered symptomatic women to be at greater than average breast cancer risk [21]. The majority of mammography malpractice suits citing delays in cancer diagnoses are initiated by women with symptoms, which could help explain the more aggressive recommendations for this group [22].…”

Impact of an Educational Intervention Designed to Reduce Unnecessary Recall during Screening Mammography

“…These data were derived from the respective mammography registries associated with the participating radiologists. Module 2 profiled breast cancer risk in each radiologist’s respective patient population, also ascertained from respective BCSC Sites, to illustrate how low breast cancer risk is in population-based settings, and Module 3 presented information on the possible impact of medical malpractice concerns on recall rates, which was shown in our previous research to influence recall rates (20, 21). …”