Volume of screening mammography and performance in the Quebec population-based Breast Cancer Screening Program

Théberge, Isabelle; Hébert‐Croteau, Nicole; Langlois, André; Major, Diane; Brisson, Jacques

doi:10.1503/cmaj.1040485

Cited by 34 publications

(39 citation statements)

References 21 publications

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“…Greater mammography reading volume by radiologists may be associated with higher reading sensitivity, although this has not been shown consistently. 9,[17][18][19][20] On the other hand, greater number of years of experience in interpreting mammograms has been associated with more false negative interpretations. 8,9,21 Radiologists who spend a greater proportion of their time in breast imaging, who are more recently trained, and who perform breast biopsies tend …”

Section: Limitationsmentioning

confidence: 99%

Disparities in Screening Mammography Services by Race/Ethnicity and Health Insurance

Rauscher

Allgood

Whitman

et al. 2012

Journal of Women's Health

105

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Background: Black and Hispanic women are diagnosed at a later stage of breast cancer than white women. Differential access to specialists, diffusion of technology, and affiliation with an academic medical center may be related to this stage disparity. Methods: We analyzed data from a mammography facility survey for the metropolitan region of Chicago, Illinois, to assess in part whether quality breast imaging services were equally accessed by non-Hispanic white, non-Hispanic black, and Hispanic women and by women with and without private insurance. Of 49 screening facilities within the city of Chicago, 43 facilities completed the survey, and 40 facilities representing about 149,000 mammograms, including all major academic facilities, provided data on patient race/ethnicity. Results: Among women receiving mammograms at the facilities we studied, white women were more likely than black or Hispanic women to have mammograms at academic facilities, at facilities that relied exclusively on breast imaging specialists to read mammograms, and at facilities where digital mammography was available ( p < 0.001). Women with private insurance were similarly more likely than women without private insurance to have mammograms at facilities with these characteristics ( p < 0.001). Conclusions: Black and Hispanic women and women without private insurance are more likely than white women and women with private insurance to obtain mammography screening at facilities with less favorable characteristics. A disparity in use of high-quality mammography may be contributing to disparities in breast cancer mortality.

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Section: Limitationsmentioning

confidence: 99%

Disparities in Screening Mammography Services by Race/Ethnicity and Health Insurance

Rauscher

Allgood

Whitman

et al. 2012

Journal of Women's Health

105

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“…Our study support findings from five studies showing volume to be of importance. [18][19][20][21][22] For example, Theberge et al 21 showed that radiologist who read more than 2,000 mammograms per year had higher sensitivity while maintaining low specificity. Our results are in contrast with those of previous studies finding that increased volume may not necessarily increase performance.…”

Section: Discussionmentioning

confidence: 99%

“…Radiologist training in general has been associated with increased performance. [12][13][14][15][16][17] Data on the relationship between volume read per radiologist and performance are, however, conflicting, 13,[18][19][20][21][22] whereas associations have been found between some other indicators of radiologists' experience and performance. [23][24][25] However, most studies focused on mammography screening, and no large community based study has evaluated the association between organisational factors and performance of diagnostic mammography.…”

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confidence: 99%

Performance of clinical mammography: A nationwide study from Denmark

Jensen

Vejborg

Severinsen

et al. 2006

Intl Journal of Cancer

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Clinical mammography is the key tool for breast cancer diagnosis, but little is known about the impact of the organisational set-up on the performance. We evaluated whether organisatorial factors influence the performance of clinical mammography. Clinical mammography data from all clinics in Denmark in the year 2000 were collected and linked to cancer outcome. Use of the National Institute of Radiation Hygiene register for identification of radiology clinics ensured comprehensive nationwide registration. We used the final mammographic assessment at the end of the imaging work-up to determine sensitivity, specificity and accuracy, the latter using a receiver-operating characteristics (ROC) analysis. In 96,534 clinical mammography examinations, sensitivity was 75% and specificity 99%. The presence of at least one high volumereading radiologist in the clinic increased accuracy (AUC 5 0.91 for <1,000 examinations/year and 0.92 for >2,000 examinations/ year, p 5 0.017). The examination volume per clinic showed no clear effect on performance, as accuracy was significantly higher in clinics with a medium number of examinations (AUC 5 0.93 for 2,000-4,000 examinations/year and 0.90 for >6,000 examinations/year, p 5 0.003). Accuracy was significantly lower in regions with high annual utilisation rate of clinical mammography, which means the proportion of examined women in a region (AUC 5 0.90 for 3.0-5.0% annual utilisation rate and AUC 5 0.93 for 2.0-2.5% annual utilisation rate, and p 5 0.001), indicating that clinical mammography worked best in patient populations of purely symptomatic women. Our data indicate that to increase the accuracy of clinical mammography at the community level, the presence of an experienced radiologist should be prioritised ahead of raising the clinic size. ' 2006 Wiley-Liss, Inc.Key words: mammography; breast cancer; organization; sensitivity; specificity; accuracy Diagnostic mammography is the most commonly used tool for diagnosing breast cancers in women with signs or symptoms of this disease. It is most often undertaken in combination with a clinical examination and supplemented with ultrasound or other imaging techniques. 1 In contrast to mammography screening, performance of diagnostic mammography has been examined only in a few studies. In addition, the majority of these studies are singleclinic studies covering small populations, 1-5 and only two studies have evaluated the performance of diagnostic mammography at the community level. 6,7 Performance of mammography is known to be influenced by factors related to woman characteristics, such as age, breast density, history of previous breast lesions and presence of symptoms. 6,[8][9][10][11] However, performance of mammography may also be related to the organisational setup, such as the type of clinic, the number of examinations undertaken and the experience of the radiologists. Radiologist training in general has been associated with increased performance. 12-17 Data on the relationship between volume read per radiologist and performan...

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“…Others have shown that this factor may not be important. [8][9][10][11][12][13][14] The study by Théberge and colleagues in this issue 1 shows that the operating characteristics of screening mammography improve with the increasing size of the facility and volume of mammograms read by individual radiologists. This finding is based on a comparative analysis of data of facility and radiologist characteristics associated with 1709 cases of screening-detected breast cancer and 3159 cases of false-positive readings in a 10% random sample of women without screening-detected breast cancer (n = 30 560) obtained from the population-based Quebec Breast Cancer Screening Program.…”

mentioning

confidence: 99%

“…In this issue (see page 195) Théberge and colleagues seek to maximize the operating characteristics of screening mammography by investigating whether the sensitivity and specificity of the test are associated with the volume of mammograms read by individual radiologists or the volume performed by individual health care facilities. 1 They conclude that radiologists who work in larger facilities and who read more screening mammograms are more likely to have higher breast cancer detection rates and lower false-positive rates.…”

mentioning

confidence: 99%

Breast cancer screening, diagnostic accuracy and health care policies

Urbain¹

2005

Canadian Medical Association Journal

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Volume of screening mammography and performance in the Quebec population-based Breast Cancer Screening Program

Cited by 34 publications

References 21 publications

Disparities in Screening Mammography Services by Race/Ethnicity and Health Insurance

Disparities in Screening Mammography Services by Race/Ethnicity and Health Insurance

Performance of clinical mammography: A nationwide study from Denmark

Breast cancer screening, diagnostic accuracy and health care policies

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