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Ho TQH, Bissell MCS, Lee CI, Lee JM, Sprague BL, Tosteson ANA, Wernli KJ, Henderson LM, Kerlikowske K, Miglioretti DL. Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation on the Basis of Risk for Recall. J Am Coll Radiol 2023; 20:299-310. [PMID: 36273501 PMCID: PMC10044471 DOI: 10.1016/j.jacr.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to develop a prioritization strategy for scheduling immediate screening mammographic interpretation and possible diagnostic evaluation. METHODS A population-based cohort with screening mammograms performed from 2012 to 2020 at 126 radiology facilities from 7 Breast Cancer Surveillance Consortium registries was identified. Classification trees identified combinations of clinical history (age, BI-RADS® density, time since prior mammogram, history of false-positive recall or biopsy result), screening modality (digital mammography, digital breast tomosynthesis), and facility characteristics (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 considered high and ≥16/100 very high. An efficiency ratio was estimated as the percentage of recalls divided by the percentage of mammograms. RESULTS The study cohort included 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The most important predictor of recall was time since prior mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening modality. Recall rates were very high for baseline mammograms (21.3/100; 95% confidence interval, 19.7-23.0) and high for women with ≥5 years since prior mammogram (15.1/100; 95% confidence interval, 14.3-16.1). The 9.2% of mammograms in subgroups with very high and high recall rates accounted for 19.2% of recalls, an efficiency ratio of 2.1 compared with a random approach. Adding women <50 years of age with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Results including facility-level characteristics were similar. CONCLUSIONS Prioritizing women with baseline mammograms or ≥5 years since prior mammogram for immediate interpretation and possible diagnostic evaluation could considerably reduce the number of women needing to return for diagnostic imaging at another visit.
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Affiliation(s)
- Thao-Quyen H Ho
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Breast Imaging Unit, Diagnostic Imaging Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam; Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam
| | - Michael C S Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California
| | - Christoph I Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Northwest Screening and Cancer Outcomes Research Enterprise, University of Washington, Seattle, Washington; Deputy Editor, JACR
| | - Janie M Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Breast Imaging, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and Co-Leader, Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, Burlington, Vermont
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Associate Director for Population Sciences, Dartmouth Cancer Center, Lebanon, New Hampshire
| | - Karen J Wernli
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; Cancer Epidemiology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, California; Women's Health Comprehensive Clinic, and Director, Advanced Postdoctoral Fellowship in Women's Health, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington; Biostatistics and Population Sciences and Health Disparities Program, University of California, Davis, Comprehensive Cancer Center, Davis, California.
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Nguyen Dolphyn TT, Ormond KE, Weissman SM, Kim HJ, Reuter CM. Patient experiences with clinical confirmatory genetic testing after using direct-to-consumer raw DNA and third-party genetic interpretation services. Transl Behav Med 2023; 13:104-114. [PMID: 36327324 DOI: 10.1093/tbm/ibac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The availability of raw DNA and genetic interpretation tools allow individuals to access genetic health risk information, where analytical false-positives exist. Little is known about the experience of individuals who receive pathogenic or likely pathogenic variant(s) through raw DNA interpretation and follow-up with clinical confirmatory genetic testing. This qualitative study set out to describe the experiences of individuals who pursued clinical confirmatory genetic testing, including their perception of the process. Participants were recruited from social media and eligible if they discovered a potential pathogenic or likely pathogenic variant in a raw DNA interpretation report, completed clinical confirmatory genetic testing in the U.S., and provided documentation of those results. Individuals participated in semi-structured interviews, which were transcribed and inductively coded to identify themes. Of the 12 participants, 3 received clinical genetic testing results that confirmed pathogenic or likely pathogenic variants noted in raw DNA interpretation reports (confirmation positive), and 9 were not confirmed. Nearly all (n = 11) participants described emotional distress and information-seeking behavior as a coping mechanism after discovering a pathogenic or likely pathogenic variant in raw DNA interpretation. When pursuing confirmatory genetic testing, many (n = 9) faced challenges with finding knowledgeable healthcare providers and obtaining insurance coverage. Despite reporting concerns over raw DNA interpretation and a desire for more safeguards, almost all (n = 10) participants stated interest in using the service again. Overall, participants' experiences reveal they find personal utility in raw DNA interpretation results and provide insight into opportunities for patient and provider education.
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Affiliation(s)
- Tiffany T Nguyen Dolphyn
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, California, 94305USA.,Stanford Medicine Clinical Genomics Program, Stanford School of Medicine, Stanford University, Stanford, California, 94305, USA
| | - Kelly E Ormond
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, California, 94305USA.,Department of Genetics and Stanford Center for Biomedical Ethics, Stanford School of Medicine, Stanford University, Stanford, California, 94305, USA.,Health Ethics and Policy Lab, Department of Health Science and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | | | - Helen J Kim
- Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, California, 94305USA
| | - Chloe M Reuter
- Stanford Center for Inherited Cardiovascular Disease, Stanford Health Care, Stanford, California, 94305, USA
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Miller MM, Vasiliadis T, Rochman CM, Repich K, Patrie JT, Anderson RT, Harvey JA. Factors associated with perceived personal risk for breast cancer among women with dense breasts. Clin Imaging 2022; 93:34-38. [DOI: 10.1016/j.clinimag.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
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Mottram R, Knerr WL, Gallacher D, Fraser H, Al-Khudairy L, Ayorinde A, Williamson S, Nduka C, Uthman OA, Johnson S, Tsertsvadze A, Stinton C, Taylor-Phillips S, Clarke A. Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis. BMJ Open 2021; 11:e046660. [PMID: 34848507 PMCID: PMC8634222 DOI: 10.1136/bmjopen-2020-046660] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Attendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance. DESIGN CINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987-June 2019, and reporting attendance in relation to at least one patient-level factor. DATA SYNTHESIS Independent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible. RESULTS Of 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence. CONCLUSIONS Attendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated. TRIAL REGISTRATION NUMBER CRD42016051597.
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Affiliation(s)
- Rebecca Mottram
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Wendy Lynn Knerr
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Daniel Gallacher
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hannah Fraser
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Abimbola Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Williamson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chidozie Nduka
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samantha Johnson
- University of Warwick Library, University of Warwick, Coventry, West Midlands, UK
| | - Alexander Tsertsvadze
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Christopher Stinton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Patient Characteristics Associated With Patient-Reported Deterrents to Adjunct Breast Cancer Screening of Patients With Dense Breasts. AJR Am J Roentgenol 2021; 217:1069-1079. [PMID: 33147054 DOI: 10.2214/ajr.20.24516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND. The success of adjunct breast cancer screening of women with dense breasts can be enhanced by identifying and addressing patient concerns regarding adjunct screening modalities. OBJECTIVE. The purpose of this study was to identify patient characteristics associated with patient-reported concerns about adjunct breast cancer screening to facilitate the development of a more effective screening model for women with dense breasts. METHODS. Patients with dense breasts completed surveys between March 2017 and February 2018 regarding factors that might deter them from adjunct screening and about which of three hypothetical screening examinations they might prefer. Additional patient data were extracted from medical records, and socioeconomic data were imputed from federal census data. Logistic regression analyses were conducted to identify associations between patient characteristics and patient attitudes toward adjunct screening. RESULTS. Surveys were completed by 508 women (median age, 59.0 years) with dense breasts. Lower confidence in the sensitivity of mammography of dense breasts was independently associated with lesser concern about adjunct screening examination time (1 divided by adjusted odds ratio [1/AOR], 0.55 [95% CI, 0.34-0.89]), additional imaging that could result (1/AOR, 0.51 [95% CI, 0.31-0.85]), and greater preference for a more sensitive hypothetical screening examination (1/AOR, 1.85 [95% CI, 1.20-2.86]). Concern about examination cost, the most commonly cited deterrent to adjunct screening (66.9%), was independently associated with younger age (1/AOR, 1.45 [95% CI, 1.01-2.08]) but not with imputed socioeconomic variables or other tested variables. Younger age was also associated with lesser concern about pain (1/AOR, 0.69 [95% CI, 0.48-0.99]), additional imaging that could result (1/AOR, 0.48 [95% CI, 0.31-0.76]), and IV contrast administration (1/AOR, 0.56 [95% CI, 0.37-0.83]). CONCLUSION. Younger age and lower confidence in the sensitivity of mammography among women with dense breasts are independently associated with lesser patient concern about common deterrents to adjunct breast cancer screening. Younger age is independently associated with greater concern about the cost of undergoing adjunct breast cancer screening. CLINICAL IMPACT. Concerns about adjunct screening may be reduced by educating patients about the lower sensitivity of mammography of dense breasts and by finding ways to address or mitigate the financial and daily-life impact of adjunct screening, especially for younger patients.
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Miller MM, Meneveau MO, Rochman CM, Schroen AT, Lattimore CM, Gaspard PA, Cubbage RS, Showalter SL. Impact of the COVID-19 pandemic on breast cancer screening volumes and patient screening behaviors. Breast Cancer Res Treat 2021; 189:237-246. [PMID: 34032985 PMCID: PMC8145189 DOI: 10.1007/s10549-021-06252-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/04/2021] [Indexed: 12/14/2022]
Abstract
Purpose In order to facilitate targeted outreach, we sought to identify patient populations with a lower likelihood of returning for breast cancer screening after COVID-19-related imaging center closures. Methods Weekly total screening mammograms performed throughout 2019 (baseline year) and 2020 (COVID-19-impacted year) were compared. Demographic and clinical characteristics, including age, race, ethnicity, breast density, breast cancer history, insurance status, imaging facility type used, and need for interpreter, were compared between patients imaged from March 16 to October 31 in 2019 (baseline cohort) and 2020 (COVID-19-impacted cohort). Census data and an online map service were used to impute socioeconomic variables and calculate travel times for each patient. Logistic regression was used to identify patient characteristics associated with a lower likelihood of returning for screening after COVID-19-related closures. Results The year-over-year cumulative difference in screening mammogram volumes peaked in week 21, with 2962 fewer exams in the COVID-19-impacted year. By week 47, this deficit had reduced by 49.4% to 1498. A lower likelihood of returning for screening after COVID-19-related closures was independently associated with younger age (odds ratio (OR) 0.78, p < 0.001), residence in a higher poverty area (OR 0.991, p = 0.014), lack of health insurance (OR 0.65, p = 0.007), need for an interpreter (OR 0.68, p = 0.029), longer travel time (OR 0.998, p < 0.001), and utilization of mobile mammography services (OR 0.27, p < 0.001). Conclusion Several patient factors are associated with a lower likelihood of returning for screening mammography after COVID-19-related closures. Knowledge of these factors can guide targeted outreach to vulnerable patients to facilitate breast cancer screening. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06252-1.
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Affiliation(s)
- Matthew M Miller
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA.
| | - Max O Meneveau
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Carrie M Rochman
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Anneke T Schroen
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Courtney M Lattimore
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Patricia A Gaspard
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Richard S Cubbage
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Shayna L Showalter
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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Squillace L, Pizzi L, Rallo F, Bazzani C, Saguatti G, Mezzetti F. Subsequent attendance in a breast cancer screening program after a false-positive result in the Local Health Authority of Bologna (Italy). Sci Rep 2021; 11:8530. [PMID: 33879804 PMCID: PMC8058078 DOI: 10.1038/s41598-021-87864-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
We conducted a cross-sectional study to assess the likelihood of returning for routine breast cancer screening among women who have experienced a false-positive result (FPR) and to describe the possible individual and organizational factors that could influence subsequent attendance to the screening program. Several information were collected on demographic and clinical characteristics data. Electronic data from 2014 to 2016 related to breast screening program of the Local Health Authority (LHA) of Bologna (Italy) of women between 45 and 74 years old were reviewed. A total of 4847 women experienced an FPR during mammographic screening and were recalled to subsequent round; 80.2% adhered to the screening. Mean age was 54.2 ± 8.4 years old. Women resulted to be less likely to adhere to screening if they were not-Italian (p = 0.001), if they lived in the Bologna district (p < 0.001), if they had to wait more than 5 days from II level test to end of diagnostic procedures (p = 0.001), if the diagnostic tests were performed in a hospital with the less volume of activity and higher recall rate (RR) (p < 0.001) and if they had no previous participation to screening tests (p < 0.001). Our results are consistent with previous studies, and encourages the implementation and innovation of the organizational characteristics for breast cancer screening. The success of screening programs requires an efficient indicators monitoring strategy to develop and evaluate continuous improvement processes.
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Affiliation(s)
- Lorena Squillace
- Department of Public Health, LHA Bologna, Via Boldrini, 12, 40121, Bologna, Italy.
| | - Lorenzo Pizzi
- Department of Public Health, LHA Bologna, Via Boldrini, 12, 40121, Bologna, Italy
| | - Flavia Rallo
- Department of Biomedical and Neuromotor Sciences, School of Hygiene and Preventive Medicine, University of Bologna, Bologna, Italy
| | - Carmen Bazzani
- Department of Public Health, LHA Bologna, Via Boldrini, 12, 40121, Bologna, Italy
| | | | - Francesca Mezzetti
- Department of Public Health, LHA Bologna, Via Boldrini, 12, 40121, Bologna, Italy
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Kang SK, Jiang M, Duszak R, Heller SL, Hughes DR, Moy L. Use of Breast Cancer Screening and Its Association with Later Use of Preventive Services among Medicare Beneficiaries. Radiology 2018; 288:660-668. [PMID: 29869958 DOI: 10.1148/radiol.2018172326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose To retrospectively assess whether there is an association between screening mammography and the use of a variety of preventive services in women who are enrolled in Medicare. Materials and Methods U.S. Medicare claims from 2010 to 2014 Research Identifiable Files were reviewed to retrospectively identify a group of women who underwent screening mammography and a control group without screening mammography in 2012. The screened group was divided into positive versus negative results at screening, and the positive subgroup was divided into false-positive and true-positive findings. Multivariate logistic regression models and inverse probability of treatment weighting were used to examine the relationship between screening status and the probabilities of undergoing Papanicolaou test, bone mass measurement, or influenza vaccination in the following 2 years. Results The cohort consisted of 555 705 patients, of whom 185 625 (33.4%) underwent mammography. After adjusting for patient demographics, comorbidities, geographic covariates, and baseline preventive care, women who underwent index screening mammography (with either positive or negative results) were more likely than unscreened women to later undergo Papanicolaou test (odds ratio [OR], 1.49; 95% confidence interval: 1.40, 1.58), bone mass measurement (OR, 1.70; 95% confidence interval: 1.63, 1.78), and influenza vaccine (OR, 1.45; 95% confidence interval: 1.37, 1.53). In women who had not undergone these preventive measures in the 2 years before screening mammography, use of these three services after false-positive findings at screening was no different than after true-negative findings at screening. Conclusion In beneficiaries of U.S. Medicare, use of screening mammography was associated with higher likelihood of adherence to other preventive guidelines, without a negative association between false-positive results and cervical cancer screening.
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Affiliation(s)
- Stella K Kang
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Miao Jiang
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Richard Duszak
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Samantha L Heller
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Danny R Hughes
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
| | - Linda Moy
- From the Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016 (S.K.K., S.L.H., L.M.); Department of Population Health, NYU Langone Medical Center, New York, NY (S.K.K.); Harvey L. Neiman Health Policy Institute, Reston, Va (M.J., D.R.H.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (R.D.); and School of Economics, Georgia Institute of Technology, Atlanda, Ga (D.R.H.)
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Gao Y, Albert M, Young Lin LL, Lewin AA, Babb JS, Heller SL, Moy L. What Happens after a Diagnosis of High-Risk Breast Lesion at Stereotactic Vacuum-assisted Biopsy? An Observational Study of Postdiagnosis Management and Imaging Adherence. Radiology 2018; 287:423-431. [DOI: 10.1148/radiol.2017171665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Marissa Albert
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Leng Leng Young Lin
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Alana A. Lewin
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - James S. Babb
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Samantha L. Heller
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
| | - Linda Moy
- From the Department of Radiology, New York University–Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., M.A., L.L.Y.L., A.A.L., J.S.B., S.L.H.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.)
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Stereotactic Breast Biopsy With Benign Results Does Not Negatively Affect Future Screening Adherence. J Am Coll Radiol 2018; 15:622-629. [PMID: 29433804 DOI: 10.1016/j.jacr.2017.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/11/2017] [Accepted: 12/22/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate whether false-positive stereotactic vacuum-assisted breast biopsy (SVAB) affects subsequent mammographic screening adherence. MATERIALS AND METHODS This Institutional Review Board-approved, HIPAA-compliant retrospective review of women with SVAB was performed between 2012 and 2014. Patient age, clinical history, biopsy pathology, and first postbiopsy screening mammogram were reviewed. Statistical analyses were performed using Fisher's exact, Mann-Whitney, and χ2 tests. RESULTS There were 913 SVABs performed in 2012 to 2014 for imaging detected lesions; of these, malignant or high-risk lesions or biopsies resulting in a recommendation of surgical excision were excluded, leaving 395 SVABs yielding benign pathology in 395 women. Findings were matched with a control population consisting of 45,126 women who had a BI-RADS 1 or 2 screening mammogram and did not undergo breast biopsy. In all, 191 of 395 (48.4%) women with a biopsy with benign results and 22,668 of 45,126 (50.2%) women without biopsy returned for annual follow-up >9 months and ≤18 months after the index examination (P = .479). In addition, 57 of 395 (14.4%) women with a biopsy with benign results and 3,336 of 45,126 (7.4%) women without biopsy returned for annual follow-up >18 months after the index examination (P < .001). Older women, women with personal history of breast cancer, and women with postbiopsy complication after benign SVAB were more likely to return for screening (P = .026, P = .028, and P = .026, respectively). CONCLUSION The findings in our study suggest that SVABs with benign results do not negatively impact screening mammography adherence. The previously described "harms" of false-positive mammography and biopsy may be exaggerated.
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Miller LS, Shelby RA, Balmadrid MH, Yoon S, Baker JA, Wildermann L, Soo MS. Patient Anxiety Before and Immediately After Imaging-Guided Breast Biopsy Procedures: Impact of Radiologist-Patient Communication. J Am Coll Radiol 2018; 13:e62-e71. [PMID: 27814826 DOI: 10.1016/j.jacr.2016.09.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to evaluate patient anxiety and its association with perceived radiologist-patient communication in the setting of imaging-guided breast biopsy. METHODS After informed consent was obtained, 138 women recommended for imaging-guided breast procedures completed questionnaires immediately before and after biopsies, measuring state anxiety using the State-Trait Anxiety Inventory (range, 20-80). Before biopsies, women also completed questionnaires regarding their perceived communication with the radiologists recommending the procedures (modified Questionnaire on the Quality of Physician-Patient Interaction), demographic characteristics, and medical history; immediately after the biopsies, they completed a measure of perceived communication with the radiologists performing the biopsies. Experience levels (eg, attending radiologist, fellow) of the radiologists recommending and performing the biopsies were recorded. Data were analyzed using paired and independent t tests, one-way analysis of variance, Pearson's correlations, and multiple linear regression analyses. RESULTS Average prebiopsy anxiety was 44.5 ± 12.4 (range, 20-77) on a scale ranging from 20 to 80 points. Perceived communication with radiologists recommending biopsies averaged 52.4 ± 11.5 (range, 18-65). Better communication with radiologists recommending biopsies was significantly associated with lower levels of prebiopsy anxiety (r = -0.22, P = .01). After the biopsies, women's anxiety significantly decreased (paired t = -7.32, P < .001). Better communication with radiologists performing biopsies (mean, 57.8 ± 8.4; range, 32-65) was associated with lower postbiopsy anxiety after accounting for patients' baseline anxiety levels (β = -0.17, P = .04). White women reported higher prebiopsy and postbiopsy anxiety; nonwhite women reported poorer communication with recommending radiologists. CONCLUSIONS Patients' perceptions of better communication with radiologists were associated with lower levels of anxiety before and after biopsies. These results have implications for radiologist training and adherence to mammographic screening.
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Affiliation(s)
- Lauren S Miller
- Riverside Radiology and Interventional Associates, Columbus, Ohio
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Sora Yoon
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Jay A Baker
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Liz Wildermann
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mary Scott Soo
- Department of Radiology, Duke University Medical Center, Durham, North Carolina.
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Dabbous FM, Dolecek TA, Berbaum ML, Friedewald SM, Summerfelt WT, Hoskins K, Rauscher GH. Impact of a False-Positive Screening Mammogram on Subsequent Screening Behavior and Stage at Breast Cancer Diagnosis. Cancer Epidemiol Biomarkers Prev 2017; 26:397-403. [PMID: 28183826 DOI: 10.1158/1055-9965.epi-16-0524] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 12/29/2022] Open
Abstract
Background: Experiencing a false positive (FP) screening mammogram is economically, physically, and emotionally burdensome, which may affect future screening behavior by delaying the next scheduled mammogram or by avoiding screening altogether. We sought to examine the impact of a FP screening mammogram on the subsequent screening mammography behavior.Methods: Delay in obtaining subsequent screening was defined as any mammogram performed more than 12 months from index mammogram. The Kaplan-Meier (product limit) estimator and Cox proportional hazards model were used to estimate the unadjusted delay and the hazard ratio (HR) of delay of the subsequent screening mammogram within the next 36 months from the index mammogram date.Results: A total of 650,232 true negative (TN) and 90,918 FP mammograms from 261,767 women were included. The likelihood of a subsequent mammogram was higher in women experiencing a TN result than women experiencing a FP result (85.0% vs. 77.9%, P < 0.001). The median delay in returning to screening was higher for FP versus TN (13 months vs. 3 months, P < 0.001). Women with TN result were 36% more likely to return to screening in the next 36 months compared with women with a FP result HR = 1.36 (95% CI, 1.35-1.37). Experiencing a FP mammogram increases the risk of late stage at diagnosis compared with prior TN mammogram (P < 0.001).Conclusions: Women with a FP mammogram were more likely to delay their subsequent screening compared with women with a TN mammogram.Impact: A prior FP experience may subsequently increase the 4-year cumulative risk of late stage at diagnosis. Cancer Epidemiol Biomarkers Prev; 26(3); 397-403. ©2017 AACR.
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Affiliation(s)
- Firas M Dabbous
- James R. & Helen D. Russell Institute for Research & Innovation, Advocate Health Care, Park Ridge, Illinois.
| | - Therese A Dolecek
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | | | | | - Kent Hoskins
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois
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Sumkin JH, Ganott MA, Chough DM, Catullo VJ, Zuley ML, Shinde DD, Hakim CM, Bandos AI, Gur D. Recall Rate Reduction with Tomosynthesis During Baseline Screening Examinations: An Assessment From a Prospective Trial. Acad Radiol 2015; 22:1477-82. [PMID: 26391857 DOI: 10.1016/j.acra.2015.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES Assess results of a prospective, single-site clinical study evaluating digital breast tomosynthesis (DBT) during baseline screening mammography. MATERIALS AND METHODS Under an institutional review board-approved Health Insurance Portability and Accountability Act (HIPAA)-compliant protocol, consenting women between ages 34 and 56 years scheduled for their initial and/or baseline screening mammogram underwent both full field digital mammography (FFDM) and DBT. The FFDM and the FFDM plus DBT images were interpreted independently in a reader by mode balanced approach by two of 14 participating radiologists. A woman was recalled for a diagnostic work-up if either radiologist recommended a recall. We report overall recall rates and related diagnostic outcome from the 1080 participants. Proportion of recommended recalls (Breast Imaging Reporting and Data System 0) were compared using a generalized linear mixed model (SAS 9.3) with a significance level of P = .0294. RESULTS The fraction of women without breast cancer recommended for recall using FFDM alone and FFDM plus DBT were 412 of 1074 (38.4%) and 274 of 1074 (25.5%), respectively (P < .001). Large inter-reader variability in terms of recall reduction was observed among the 14 readers; however, 11 of 14 readers recalled fewer women using FFDM plus DBT (5 with P < .015). Six cancers (four ductal carcinomas in situ [DCIS] and two invasive ductal carcinomas [IDC]) were detected. One IDC was detected only on DBT and one DCIS cancer was detected only on FFDM, whereas the remaining cancers were detected on both modalities. CONCLUSIONS The use of FFDM plus DBT resulted in a significant decrease in recall rates during baseline screening mammography with no reduction in sensitivity.
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Discrepant screening mammography assessments at blinded and non-blinded double reading: impact of arbitration by a third reader on screening outcome. Eur Radiol 2015; 25:2821-9. [DOI: 10.1007/s00330-015-3711-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/16/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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Blinded double reading yields a higher programme sensitivity than non-blinded double reading at digital screening mammography: A prospected population based study in the south of The Netherlands. Eur J Cancer 2015; 51:391-9. [DOI: 10.1016/j.ejca.2014.12.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/06/2014] [Accepted: 12/11/2014] [Indexed: 11/20/2022]
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16
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Setz-Pels W, Duijm LEM, Coebergh JW, Rutten M, Nederend J, Voogd AC. Re-attendance after false-positive screening mammography: a population-based study in the Netherlands. Br J Cancer 2013; 109:2044-50. [PMID: 24052045 PMCID: PMC3798969 DOI: 10.1038/bjc.2013.573] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 08/20/2013] [Accepted: 08/26/2013] [Indexed: 11/09/2022] Open
Abstract
Background: In the current study, mammography adherence of women who had experienced a false-positive referral is evaluated, with emphasis on the probability of receiving surveillance mammography outside the national screening programme. Methods: We included 424 703 consecutive screens and collected imaging, biopsy and surgery reports of 3463 women who experienced a false-positive referral. Adherence to screening, both in and outside the screening programme, was evaluated. Results: Two years after the false-positive referral, overall screening adherence was 94.6%, with 64.7% of women returning to the national screening programme, compared with 94.9% of women re-attending the screening programme after a negative screen (P<0.0001). Four years after the false-positive screen, the overall adherence had decreased to 85.2% (P<0.0001) with a similar proportion of the women re-attending the screening programme (64.4%) and a lower proportion (20.8%) having clinical surveillance mammography. Women who had experienced a false-positive screen at their first screening round were less likely to adhere to mammography than women with an abnormal finding at one of the following screening rounds (92.4% vs 95.5%, P<0.0001). Conclusion: Overall screening adherence after previous false-positive referral was comparable to the re-attendance rate of women with a negative screen at 2-year follow-up. Overall adherence decreased 4 years after previous false-positive referral from 94.6% to 85.2%, with a relatively high estimate of women who continue with clinical surveillance mammography (20.8%). Women with false-positive screens should be made aware of the importance to re-attend future screening rounds, as a way to improve the effectiveness of the screening programme.
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Affiliation(s)
- W Setz-Pels
- Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands
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Maxwell AJ, Beattie C, Lavelle J, Lyburn I, Sinnatamby R, Garnett S, Herbert A. The effect of false positive breast screening examinations on subsequent attendance: retrospective cohort study. J Med Screen 2013; 20:91-8. [PMID: 24009091 DOI: 10.1177/0969141313499147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To investigate the effect of false positive breast screening examination results on subsequent attendance in the UK National Health Service Breast Screening Programme. Methods 253,017 previously screened women who were invited for rescreening were studied. Attendance rates of women who had received a normal result at the last (index) screen were compared with those of women who had received a false positive result. The effects of age, type of index screening examination (prevalent or incident) and tissue sampling at assessment were investigated. Results Women who had a false positive prevalent index screening examination were significantly more likely to reattend than those who had a normal prevalent index screening examination (87.7% vs. 86.0%). There was no significant difference in reattendance rates between women who had a false positive incident index screening examination and those with a normal incident index screening examination. However, women who underwent needle sampling or open biopsy following false positive incident index screening examinations were 12% and 60% less likely to reattend, respectively, than women whose index screening examinations were normal ( p < 0.001), although there was variation between centres. Increasing age significantly reduced the likelihood of reattendance. The overall reattendance of women who had been screened only once was six percentage points lower than that of women who had been screened more than once. Conclusions The findings suggest that most women who undergo the breast screening assessment process retain confidence in breast screening. Needle sampling and open biopsy should be used judiciously in the assessment of screen-detected abnormalities in view of the reduced reattendance that results from their use after incident screening examinations.
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Affiliation(s)
- Anthony J Maxwell
- Consultant radiologist, Breast Unit, Royal Bolton Hospital, Bolton, UK (Current address: The Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Wythenshawe, Manchester, M23 9LT, UK)
| | - Cathryn Beattie
- Consultant radiologist, Breast Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Janet Lavelle
- Consultant radiologist, Breast Screening Unit, Lancaster Royal Infirmary, Lancaster, UK
| | - Iain Lyburn
- Consultant radiologist, Thirlestaine Breast Centre, Cheltenham, UK
| | - Ruchi Sinnatamby
- Consultant radiologist, Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Shelagh Garnett
- Screening lead, NHS North West, Manchester (Current address: NHS England, Lancashire Area Team, Preston Business Centre, Watling Street Rd, Preston)
| | - Annie Herbert
- Statistician, Biostatistics Group, University of Manchester, Manchester (Current address: MRC Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, 30 Guildford Street, London)
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Patient Anxiety Before and Immediately After Imaging-Guided Breast Biopsy Procedures: Impact of Radiologist-Patient Communication. J Am Coll Radiol 2013; 10:423-31. [DOI: 10.1016/j.jacr.2012.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 11/06/2012] [Indexed: 11/20/2022]
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Armstrong K, Handorf EA, Chen J, Bristol Demeter MN. Breast cancer risk prediction and mammography biopsy decisions: a model-based study. Am J Prev Med 2013; 44:15-22. [PMID: 23253645 PMCID: PMC3527848 DOI: 10.1016/j.amepre.2012.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 09/27/2012] [Accepted: 10/02/2012] [Indexed: 01/25/2023]
Abstract
BACKGROUND Controversy continues about screening mammography, in part because of the risk of false-negative and false-positive mammograms. Pre-test breast cancer risk factors may improve the positive and negative predictive value of screening. PURPOSE To create a model that estimates the potential impact of pre-test risk prediction using clinical and genomic information on the reclassification of women with abnormal mammograms (BI-RADS3 and BI-RADS4 [Breast Imaging-Reporting and Data System]) above and below the threshold for breast biopsy. METHODS The current study modeled 1-year breast cancer risk in women with abnormal screening mammograms using existing data on breast cancer risk factors, 12 validated breast cancer single-nucleotide polymorphisms (SNPs), and probability of cancer given the BI-RADS category. Examination was made of reclassification of women above and below biopsy thresholds of 1%, 2%, and 3% risk. The Breast Cancer Surveillance Consortium data were collected from 1996 to 2002. Data analysis was conducted in 2010 and 2011. RESULTS Using a biopsy risk threshold of 2% and the standard risk factor model, 5% of women with a BI-RADS3 mammogram had a risk above the threshold, and 3% of women with BI-RADS4A mammograms had a risk below the threshold. The addition of 12 SNPs in the model resulted in 8% of women with a BI-RADS3 mammogram above the threshold for biopsy and 7% of women with BI-RADS4A mammograms below the threshold. CONCLUSIONS The incorporation of pre-test breast cancer risk factors could change biopsy decisions for a small proportion of women with abnormal mammograms. The greatest impact comes from standard breast cancer risk factors.
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Affiliation(s)
- Katrina Armstrong
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
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20
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Setz-Pels W, Duijm LEM, Louwman MWJ, Roumen RMH, Jansen FH, Voogd AC. Characteristics and screening outcome of women referred twice at screening mammography. Eur Radiol 2012; 22:2624-32. [PMID: 22696156 DOI: 10.1007/s00330-012-2523-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/20/2012] [Accepted: 05/06/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine the characteristics and screening outcome of women referred twice at screening mammography. METHODS We included 424,703 consecutive screening mammograms and collected imaging, biopsy and surgery reports of women with screen-detected breast cancer. Review of screening mammograms was performed to determine whether or not an initial and second referral comprised the same lesion. RESULTS The overall positive predictive value of referral for cancer was 38.6% (95% CI 37.3-39.8%). Of 147 (2.6%) women referred twice, 86 had been referred for a different lesion at second referral and 32 of these proved malignant (37.2%, 95% CI 27.0-47.4%). Sixty-one women had been referred twice for the same lesion, of which 22 proved malignant (36.1%, 95% CI 24.1-48.0%). Characteristics of these women were comparable to women with cancer diagnosed after first referral. Compared with women without cancer at second referral for the same lesion, women with cancer more frequently showed suspicious densities at screening mammography (86.4% vs 53.8%, P = 0.02) and work-up at first referral had less frequently included biopsy (22.7% vs 61.5%, P = 0.004). CONCLUSIONS Cancer risk in women referred twice for the same lesion is similar to that observed in women referred once, or referred for a second time but for a different lesion. KEY POINTS Cancer risk was 36% for lesions referred twice at screening mammography. The cancer risk was similar for lesions referred only once at screening. Densities at first referral were associated with increased cancer risk at second referral. No biopsy at first referral was associated with increased cancer risk at second referral. Patient and tumour characteristics were similar for women with and without diagnostic delay.
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Affiliation(s)
- Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
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21
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DeFrank JT, Rimer BK, Bowling JM, Earp JA, Breslau ES, Brewer NT. Influence of false-positive mammography results on subsequent screening: do physician recommendations buffer negative effects? J Med Screen 2012; 19:35-41. [PMID: 22438505 PMCID: PMC5835966 DOI: 10.1258/jms.2012.011123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Cancer screening guidelines often include discussion about the unintended negative consequences of routine screening. This prospective study examined effects of false-positive mammography results on women's adherence to subsequent breast cancer screening and psychological well-being. We also assessed whether barriers to screening exacerbated the effects of false-positive results. METHODS We conducted secondary analyses of data from telephone interviews and medical claims records for 2406 insured women. The primary outcome was adherence to screening guidelines, defined as adherent (10-14 months), delayed (15-34 months), or no subsequent mammogram on record. RESULTS About 8% of women reported that their most recent screening mammograms produced false-positive results. In the absence of self-reported advice from their physicians to be screened, women were more likely to have no subsequent mammograms on record if they received false-positive results than if they received normal results (18% vs. 7%, OR = 3.17, 95% CI = 1.30, 7.70). Receipt of false-positive results was not associated with this outcome for women who said their physicians had advised regular screening in the past year (7% vs. 10%, OR = 0.74, 95% CI = 0.38, 1.45). False-positive results were associated with greater breast cancer worry (P < .01), thinking more about the benefits of screening (P < .001), and belief that abnormal test results do not mean women have cancer (P < .01), regardless of physicians' screening recommendations. CONCLUSION False-positive mammography results, coupled with reports that women's physicians did not advise regular screening, could lead to non-adherence to future screening. Abnormal mammograms that do not result in cancer diagnoses are opportunities for physicians to stress the importance of regular screening.
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Affiliation(s)
- Jessica T DeFrank
- Gillings School of Global Public Health, 325 Rosenau Hall CB# 7440, Chapel Hill, North Carolina 27599, USA.
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Hahm MI, Choi KS, Lee HY, Jun JK, Oh D, Park EC. Who participates in the gastric cancer screening and on-time rescreening in the National Cancer Screening Program? A population-based study in Korea. Cancer Sci 2011; 102:2241-7. [PMID: 21895871 DOI: 10.1111/j.1349-7006.2011.02090.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Gastric cancer (GC) screening is a major challenge in countries where the disease is highly prevalent. This study was conducted to identify the factors associated with participation in GC screening and on-time rescreening among the average-risk population in Korea. The study population was derived from the National Cancer Screening Program database. The population for this study was 22 913 618 individuals aged ≥40 years who had been invited to participate in a GC screening program from 2005 to 2006. We determined whether these individuals had attended the GC screening program and which method - an upper gastrointestinal series (UGIS) or endoscopy-they underwent. We followed the participants to determine whether they had a second GC screening after 2 years. The overall participation rate in the GC screening was 20.5%. More people underwent UGIS than endoscopy. Individuals who had been screened by endoscopy rather than UGIS were more likely to be younger, male, or those who were National Health Insurance (NHI) beneficiaries with a higher premium rate. Of those who underwent baseline screening, 59.4% participated in a rescreening program 2 years later. NHI beneficiaries with a higher premium rate were significantly more likely to be rescreened than medical aid recipients. The results from this study showed that the UGIS were more commonly used in organized GC screenings in Korea, and those who underwent UGIS were more likely to return for subsequent screening compared to those who underwent an endoscopy.
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Affiliation(s)
- Myung-Il Hahm
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Choongchungnam-do, Korea
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Effect of false-positives and women’s characteristics on long-term adherence to breast cancer screening. Breast Cancer Res Treat 2011; 130:543-52. [DOI: 10.1007/s10549-011-1581-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
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Alamo-Junquera D, Murta-Nascimento C, Macià F, Baré M, Galcerán J, Ascunce N, Zubizarreta R, Salas D, Román R, Castells X, Sala M. Effect of false-positive results on reattendance at breast cancer screening programmes in Spain. Eur J Public Health 2011; 22:404-8. [PMID: 21558152 DOI: 10.1093/eurpub/ckr057] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Mammography is the only breast screening method, we are aware of today, which is able to reduce mortality from breast cancer. Nevertheless, this procedure carries an inherent risk of false-positive screening mammogram. The association between these results and reattendance at the next scheduled screening mammogram is controversial. The aim of this study was to examine the effect of a false-positive screening mammogram and women's characteristics on reattendance in eight regional population-based breast cancer screening programmes in Spain. METHODS This study included 1 383 032 women aged 44-67 years who were initially screened for breast cancer between 1990 and 2004. To investigate factors associated with reattendance, logistic regression models were used. RESULTS The mean age of women at first screening was 53.6 years (SD = 6.1 years). Of 120 800 women with a false-positive screening mammogram, 78.3% returned for a subsequent screening mammogram compared with 81.9% of those with a negative result (P < 0.001). Multivariate analysis showed that women with a false-positive result at first screening mammogram were less likely to reattend (OR = 0.71; 95% CI 0.70-0.73) and that the likelihood was lower in those who had undergone invasive additional tests (OR = 0.56; 95% CI 0.53-0.59). CONCLUSION A false-positive screening mammogram in the first screening negatively affected attendance at the subsequent screening. The results of this study could be useful to improve the screening process and to increase women's compliance.
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Affiliation(s)
- Dolores Alamo-Junquera
- Servei d'Epidemiologia i Avaluació. Hospital del Mar - Parc de Salut Mar, Barcelona, Spain
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Johns LE, Moss SM. False-positive results in the randomized controlled trial of mammographic screening from age 40 ("Age" trial). Cancer Epidemiol Biomarkers Prev 2010; 19:2758-64. [PMID: 20837718 DOI: 10.1158/1055-9965.epi-10-0623] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND False-positive recall is a recognized disadvantage of mammographic breast screening, and the rate of such recalls may be higher in younger women, potentially limiting the value of screening below age 50. METHODS Attendance and screening outcome data for 53,884 women in the intervention arm of the U.K. Age trial were analyzed to report observed false-positive recall rates during 13 years of trial fieldwork. The Age trial was a randomized controlled trial of the effect of mammographic screening from age 40 on breast cancer mortality, conducted in 23 National Health Service screening centers between 1991 and 2004. Women randomized to the intervention arm were offered annual invitation to mammography from age 40 or 41 to age 48. RESULTS Overall, 7,893 women (14.6% of women the intervention arm and 18.1% of women attending at least one routine screen) experienced one or more false-positive screen during the trial. The rates of false-positive mammography at first and subsequent routine screens were 4.9% and 3.2%, respectively. The cumulative false-positive rate over seven screens was 20.5%. Eighty-nine percent of women who had a false-positive recall at their previous screen attended their next invitation to routine screening. CONCLUSIONS The rates of false-positive recall in the Age trial were comparable with the national screening program; however, the positive predictive value of referral was lower. Experiencing a false-positive screen did not seem to lessen the likelihood of re-attendance in the trial. IMPACT The question of greatly increased false-positive rates in this age group and of their compromising re-attendance is refuted by the findings of this study.
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Affiliation(s)
- Louise E Johns
- Cancer Screening Evaluation Unit, Institute of Cancer Research, Sutton, Surrey, United Kingdom.
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Association of diagnostic work-up with subsequent attendance in a breast cancer screening program for false-positive cases. Breast Cancer Res Treat 2010; 127:221-8. [PMID: 20809364 DOI: 10.1007/s10549-010-1118-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 08/06/2010] [Indexed: 10/19/2022]
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Bangsbøll Andersen S, Vejborg I, von Euler-Chelpin M. Participation behaviour following a false positive test in the Copenhagen mammography screening programme. Acta Oncol 2009; 47:550-5. [PMID: 18465321 DOI: 10.1080/02841860801935483] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There is an ongoing debate concerning possible disadvantages of mammography screening, one being the consequence of receiving a false positive test-result. It is argued that receiving a false positive answer may have short- and/or long-term adverse psychological effects on women, but results from different studies are conflicting. We tested if there was a difference in continued participation behaviour between the group of women who have been subject to a false positive result and those who have not. MATERIAL AND METHODS The study used the registers from the first six invitation rounds of the mammography screening programme in Copenhagen (1991-2003). We estimated the relative risk of not participating in the subsequent screening round for women with a false positive test using women with a negative test as baseline. As outcome measure odds ratios (OR) with 95% confidence intervals (CI) were used. RESULTS There was no significant difference in participation in the subsequent round between women with a false positive test and women with a negative test. The proportion of screens resulting in false positive answers, both after assessment and after surgery, decreased from 5.54% in Round 1 to 1.79% in Round 5. Participation in the subsequent screening round was well above 80% in all five screening rounds. DISCUSSION Our results showed that women experiencing a false positive test at mammography screening participated in the subsequent screening round to the same extent as did women experiencing a negative screening test, regardless of whether the false positive statement was given following assessment or following surgery. The benign to malignant biopsy ratio, comparing the type B false positives to the true positives, was by the fifth round well below the desirable level of </=1:4, recommended by the European guidelines. Other possible adverse effects should be further investigated.
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False-positive Mammography Examinations. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50053-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Carlos RC, Fendrick AM, Ellis J, Bernstein SJ. Can breast and cervical cancer screening visits be used to enhance colorectal cancer screening? J Am Coll Radiol 2007; 1:769-76. [PMID: 17411698 DOI: 10.1016/j.jacr.2004.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Despite high acceptance levels of mammography and cervical cancer screening by U.S. women, adherence with colorectal cancer screening remains suboptimal. A better understanding of the relationship among cancer screening behaviors by women may provide insight into interventions to enhance colorectal cancer screening. METHODS Women 50 years and older who participated in the 2000 Behavioral Risk Factors Surveillance Survey and lived in one of the five states that administered the colorectal cancer module (Colorado, Illinois, Massachusetts, Ohio, and Utah) were queried regarding cancer screening patterns. Predictors of colorectal cancer screening were determined using multivariate analysis from sociodemographic data and non-colorectal cancer screening adherence rates (based on American Cancer Society guidelines). RESULTS Among the 1300 colorectal cancer module respondents, cancer screening adherence was significantly less for colorectal cancer (24.9%) compared with cervical cancer (57.2%) or breast cancer (78.6%). In multivariate analysis, increasing age, health insurance, adherence with cervical cancer screening (adjusted odds ratio [OR] 2.09, p < 0.01) and adherence with breast cancer screening (adjusted OR 1.89, p < 0.01) were independent predictors of colorectal cancer screening. Participants who adhered to both mammography and Pap smear guidelines were significantly more likely to adhere to colorectal cancer screening compared with women who adhered to either screening test alone (adjusted OR 1.88, p < 0.001). CONCLUSIONS Women adherent to mammography and cervical cancer screening guidelines were significantly more likely to undergo colorectal cancer screening than those who were not adherent, although colorectal cancer acceptance in the adherent group was still suboptimal. Because psychological barriers to colorectal cancer screening exist, non-colorectal cancer screening visits that women already readily accept potentially represent a setting (or "teachable moment") for the delivery of education and behavior-related interventions aimed at reducing the burden of colorectal cancer.
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Affiliation(s)
- Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109-0030, USA.
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Schell MJ, Yankaskas BC, Ballard-Barbash R, Qaqish BF, Barlow WE, Rosenberg RD, Smith-Bindman R. Evidence-based target recall rates for screening mammography. Radiology 2007; 243:681-9. [PMID: 17517927 DOI: 10.1148/radiol.2433060372] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively identify target recall rates for screening mammography on the basis of how sensitivity shifts with recall rate. MATERIALS AND METHODS The study group included 1 872 687 subsequent and 171 104 first screening mammograms from 1996 to 2001 from 172 and 139 facilities, respectively, in six sites of the Breast Cancer Surveillance Consortium. Institutional review board (IRB) approval was obtained from each site. Informed consent requirements of the IRBs were followed. The study was HIPAA compliant. Recall rate was defined as the percentage of screening studies for which further work-up was recommended by the radiologist. Sensitivity was defined as the proportion of cancers that were detected at screening mammography. Piecewise linear regression was used to model sensitivity as a function of recall rate. This model allows detection of critical recall rates in which significant changes (shifts) occurred in the rates that sensitivity increased with increasing recall rate. Rates were interpreted as number of additional work-ups per additional cancer detected (AW/ACD) or, in other words, the estimated number of additional women needed to be recalled at a given rate to detect one additional cancer. RESULTS For first mammograms, a single shift in the estimated AW/ACD rate occurred at a recall rate of 10.0%, with the rate jumping dramatically from 35 to 172. For subsequent mammograms, four shifts were identified. At a recall rate of 6.7%, the estimated AW/ACD increased from 80 to 132, which rendered it the highest desirable target recall rate. At a recall rate of 12.3%, the estimated AW/ACD was 304, which suggests little benefit for any higher recall rate. CONCLUSION Recall rates of 10.0% for first and 6.7% for subsequent mammograms are recommended targets on the basis of their AW/ACD rates (less than 100).
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Affiliation(s)
- Michael J Schell
- Biostatistics Division, Department of Interdisciplinary Oncology, Moffitt Research Center, 12902 Magnolia Dr, Tampa, FL 33612-9497, USA.
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Ganott MA, Sumkin JH, King JL, Klym AH, Catullo VJ, Cohen CS, Gur D. Screening Mammography: Do Women Prefer a Higher Recall Rate Given the Possibility of Earlier Detection of Cancer? Radiology 2006; 238:793-800. [PMID: 16505392 DOI: 10.1148/radiol.2383050852] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively survey women undergoing screening mammography to assess their attitudes toward and preference for the level of recall rates given the possibility that an increase in recall rates may result in earlier detection of cancer. MATERIALS AND METHODS This HIPAA-compliant survey was performed with an institutional review board-approved protocol. Women who arrived for their routine screening mammographic examination from November 2004 to March 2005 were informed before they consented to participate. The distribution of responses for each survey question was summarized, and proportions for the entire group and different subgroups were computed. The z score statistic was used to assess significant differences between subgroups. RESULTS Fifteen hundred seventy anonymized questionnaires were collected; 1171 (75%) were from women between 40 and 59 years of age. Of 1528 respondents, 1486 (97%) believed that a false-positive result would not deter them from continuing with regular screening, and most would have been willing to be recalled more often for either a noninvasive (86% [1308 of 1519 respondents]) or an invasive (82% [1248 of 1515 respondents]) procedure if it might increase the chance of detecting a cancer (if present) earlier. Compared with respondents undergoing their initial screening mammographic examination, women who had undergone at least one prior screening examination reported that they were more likely to continue with screening if they had received a previous false-positive result (P = .02). Women younger than 60 years and those previously recalled were more willing to be called back more often for a noninvasive or, when indicated, an invasive procedure (P < .05). CONCLUSION A substantial fraction of women in this study would have preferred the inconvenience of and anxiety associated with a higher recall rate if it resulted in the possibility of detecting breast cancer earlier.
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Affiliation(s)
- Marie A Ganott
- Department of Radiology, University of Pittsburgh Medical Center, Imaging Research, Suite 4200, PA 15213, USA
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Abstract
As part of day-to-day practice, the most frequent role of the radiologist is to provide diagnostic information derived from imaging that will help the clinician better manage patient care. In essence, radiologists are reimbursed for the information we provide. The value of diagnostic information, however, extends beyond strict clinical and monetary value. The objectives of this paper are to provide the framework for understanding the "value" of diagnostic imaging. The article focuses on the application of these concepts using examples from the literature with particular emphasis on screening and suggests using a screening test experience as a means of improving health behavior.
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Affiliation(s)
- Ruth C Carlos
- University of Michigan, Department of Radiology/MRI, Ann Arbor, Michigan 48109-0030, USA.
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Duijm LEM, Groenewoud JH, Hendriks JHCL, de Koning HJ. Independent Double Reading of Screening Mammograms in the Netherlands: Effect of Arbitration Following Reader Disagreements. Radiology 2004; 231:564-70. [PMID: 15044742 DOI: 10.1148/radiol.2312030665] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively determine the value of arbitration by a panel of radiologists when two radiologists performing independent readings of screening mammograms do not reach a consensus about referral. MATERIALS AND METHODS The study population consisted of women who participated in the Dutch Nationwide Breast Cancer Screening Program, in which biennial screening is offered to women aged 50-75 years. An arbitration panel of three radiologists assessed those screening mammograms for which two screening radiologists did not reach a consensus about referral necessity. Women were referred for further analysis if at least one arbitration panel radiologist considered referral to be necessary. RESULTS The two screening radiologists agreed on the recommendation for referral of 498 (0.8%) of 65,779 screened women and on the recommendation for no referral of 64,949 (98.7%) women. They initially disagreed about the referral in 332 (0.5%) cases. After a mutual consultation, disagreement persisted regarding 183 (0.3%) mammograms. The arbitration panel referred 89 of these cases for further analysis, which revealed cancer in 20 (22%) cases. In three (3%) of the 94 cases that were not referred by the panel, breast cancer was detected at the site of previously discrepant mammographic findings seen at subsequent screening performed 2 years later. If all 183 discrepant cases had been referred, the referral rate would have increased from 0.8% to 0.9% at subsequent (incident) screenings and from 1.5% to 1.7% at initial screenings. In addition, at subsequent screenings, the number of cancers detected per 1,000 women screened would have increased from 4.4 to 4.5. CONCLUSION Mammograms with discrepant findings constitute a very important subset of screening mammograms. All lesions that are subsequently proved to be malignant may not be detected with panel arbitration.
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Affiliation(s)
- Lucien E M Duijm
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
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