Mammography use and outcomes in a community the greater lansing area mammography study

Abstract

Background. Mammography is widely known to reduce morbidity and mortality from breast cancer, but a population‐based assessment of mammography use and follow‐up of mammography findings has not been reported previously. Methods. An observational, population‐based, follow‐up study was conducted of all women having mammograms in the Greater Lansing, Michigan, metropolitan area, between June 1987 and June 1988. A total of 17,811 Greater Lansing women participated. The adherence of women to mammography screening guidelines was estimated, and mammography's utility to detect breast cancer was assessed through follow‐up review of breast biopsy results. Results. Thirty‐seven percent of the expected number of women 35 years of age and older had mammograms. Adherence to screening guidelines declined with age, and less than 5% (302 of 6700) of women 55 years of age and older reporting having annual mammograms. Seventy‐six percent of women reported that their physicians prompted the examination. The predictive value of a positive mammogram was 21.9% for women without symptoms and 32.4% for women with symptoms. Mammography's sensitivity and specificity for breast cancer detection were 71% and 98%, respectively. Conclusions. The study highlights the need to target mammography to women 50 years of age and older, underscores the importance of physicians in promoting mammography, and demonstrates the analytic value and limitation of mammography in clinical decision‐making.

Sensitivity, specificity and predictive values of breast imaging in the detection of cancer

“…Locker et al (1989) calculated a sensitivity of 88% in a symptomatic population, but again follow-up information was not specified. In a largely asymptomatic population Sienko et al (1993) reported a sensitivity of 71% only and a specificity of 98%. In all studies mentioned above ultrasound was not used in the radiological work-up of breast disease.…”

“…Comparison with other series is difficult as the positive predictive value of breast imaging depends on several other factors as well (Kopans, 1992). However, the integral use of mammography and ultrasonography will have helped us to obtain a positive predictive value that was substantially higher than in diagnostic studies in which ultrasound was not used (Wolfe et al, 1987;Robertson, 1993;Sienko et al, 1993).…”

“…The sensitivity and specificity of mammography in the detection of breast cancer have been reported in several screening studies (Tabar et al, 1984;Baines et al, 1986;Bird, 1989;Sickles et al, 1990;Robertson, 1993) and diagnostic (consultative) studies (Wolfe et al, 1987;Hansell et al, 1988;Reintgen et al, 1993;Robertson, 1993;Sienko et al, 1993). However, in diagnostic studies, these parameters have frequently been determined retrospectively in pathologically proven breast cancers (Hansell et al, 1988;Reintgen et al, 1993).…”

“…However, in diagnostic studies, these parameters have frequently been determined retrospectively in pathologically proven breast cancers (Hansell et al, 1988;Reintgen et al, 1993). Moreover, the follow-up period has usually been 12 months or less (Wolfe et al, 1987;Robertson, 1993), and the proportion of patients lost to follow-up has not been well defined in many of the studies (Baines et al, 1986;Bird, 1989;Sienko et al, 1993). For these reasons, the actual sensitivity and specificity of breast imaging in the detection of breast cancer will be lower than reported.…”

Interventions to improve follow-up of abnormal findings in cancer screening

“…Inclusion criteria are often based on the degree, level, or seriousness of the abnormality 6, 13, 71–73, 83, 84, 89–91. For example, Sienko et al91 only included women with a mammographically detected abnormality necessitating a biopsy, whereas Haas et al90 included women with any type of abnormal mammogram results as well as women with clinical breast symptoms. In the area of cervical cancer, Palm et al83 included a wide range of abnormalities from mild dysplasia to invasive cancer, whereas Batal et al84 included only women with atypical squamous cells of undetermined significance or any dysplasia.…”