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International variation in screening mammography interpretations in community-based programs.

ABSTRACT: BACKGROUND:Variations in mammography interpretations may have important clinical and economic implications. To evaluate international variability in mammography interpretation, we analyzed published reports from community-based screening programs from around the world. METHODS:A total of 32 publications were identified in MEDLINE that fit the study inclusion criteria. Data abstracted from the publications included features of the population screened, examination technique, and clinical outcomes, including the percentage of mammograms judged to be abnormal, positive predictive value of an abnormal mammogram (PPV(A)), positive predictive value of a biopsy performed (PPV(B)), and percentages of breast cancer patients with ductal carcinoma in situ (DCIS) and minimal disease (DCIS and/or tumor size < or =10 mm). North American screening programs were compared with those from other countries using meta-regression analysis. All statistical tests were two-sided. RESULTS:Wide ranges were noted for the percentage of mammograms judged to be abnormal (1.2%-15.0%), for PPV(A) (3.4%-48.7%), for PPV(B) (5.0%-85.2%), for percentage diagnosed with DCIS (4.3%-68.1%), and for percentage diagnosed with minimal disease (14.0%-80.6%). The percentage of mammograms judged to be abnormal were 2-4 percentage points higher in North American screening programs than they were in programs from other countries, after adjusting for covariates such as percentage of women who were less than 50 years of age and calendar year in which the mammogram was performed. The percentage of mammograms judged to be abnormal had a negative association with PPV(A) and PPV(B) (both P<.001) and a positive association with the frequency of DCIS cases diagnosed (P =.008) and the number of DCIS cases diagnosed per 1000 screens (P =.024); no consistent relationship was observed with the proportion of breast cancer diagnoses reported as having minimal disease or the number of minimal disease cases diagnosed per 1000 screens. CONCLUSION:North American screening programs appear to interpret a higher percentage of mammograms as abnormal than programs from other countries without evident benefit in the yield of cancers detected per 1000 screens, although an increase in DCIS detection was noted.

SUBMITTER: Elmore JG

PROVIDER: S-EPMC3146363 | biostudies-literature | 2003 Sep

REPOSITORIES: biostudies-literature

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International variation in screening mammography interpretations in community-based programs.

Elmore Joann G JG Nakano Connie Y CY Koepsell Thomas D TD Desnick Laurel M LM D'Orsi Carl J CJ Ransohoff David F DF

Journal of the National Cancer Institute 20030901 18

<h4>Background</h4>Variations in mammography interpretations may have important clinical and economic implications. To evaluate international variability in mammography interpretation, we analyzed published reports from community-based screening programs from around the world.<h4>Methods</h4>A total of 32 publications were identified in MEDLINE that fit the study inclusion criteria. Data abstracted from the publications included features of the population screened, examination technique, and cli ...[more]

PMID: 13130114

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Project description:PurposeTo evaluate the effect of comparison mammograms on accuracy, sensitivity, specificity, positive predictive value (PPV(1)), and cancer detection rate (CDR) of screening mammography to determine the role played by identification of change on comparison mammograms.Materials and methodsThis HIPAA-compliant and institutional review board-approved prospective study was performed with waiver of patient informed consent. A total of 1,157,980 screening mammograms obtained between 1994 and 2008 in 435,183 women aged at least 40 years were included. Radiologists recorded presence of comparison mammograms and change, if seen. Women were followed for 1 year to monitor cancer occurrence. Performance measurements were calculated for screening with comparison mammograms versus screening without comparison mammograms and for screening with comparison mammograms that showed a change versus screening with comparison mammograms that did not show a change while controlling for age, breast density, and data clustering.ResultsComparison mammograms were available in 93% of examinations. For screening with comparison mammograms versus screening without comparison mammograms, CDR per 1000 women was 3.7 versus 7.1; recall rate, 6.9% versus 14.9%; sensitivity, 78.9% versus 87.4%; specificity, 93.5% versus 85.7%; and PPV(1), 5.4% versus 4.8%. For screening with comparison mammograms that showed a change versus screening with comparison mammograms that did not show a change, CDR per 1000 women was 25.4 versus 0.8; recall rate, 41.4% versus 2.0%; sensitivity, 96.6% versus 43.5%; specificity, 60.4% versus 98.1%; and PPV(1), 6.0% versus 3.9%. Detected cancers with change were 21.1% ductal carcinoma in situ and 78.9% invasive carcinoma. Detected cancers with no change were 19.3% ductal carcinoma in situ and 80.7% invasive carcinoma.ConclusionPerformance is affected when change from comparison mammograms is noted. Without change, sensitivity is low and specificity is high. With change, sensitivity is high, with a high false-positive rate (low specificity). Further work is needed to appreciate changes that might indicate cancer and to identify changes that are likely not indicative of cancer.

Project description:ObjectiveTo use data from two longstanding, population based screening programmes to study overdiagnosis in screening mammography.DesignPopulation based cohort study.SettingCopenhagen municipality (from 1991) and Funen County (from 1993), Denmark.Participants57,763 women targeted by organised screening, aged 56-69 when the screening programmes started, and followed up to 2009.Main outcome measuresOverdiagnosis of breast cancer in women targeted by screening, assessed by relative risks compared with historical control groups from screening regions, national control groups from non-screening regions, and historical national control groups.ResultsIn total, 3279 invasive breast carcinomas and ductal carcinomas in situ occurred. The start of screening led to prevalence peaks in breast cancer incidence: relative risk 2.06 (95% confidence interval 1.64 to 2.59) for Copenhagen and 1.84 (1.46 to 2.32) for Funen. During subsequent screening rounds, relative risks were slightly above unity: 1.04 (0.85 to 1.27) for Copenhagen and 1.14 (0.98 to 1.32) for Funen. A compensatory dip was seen after the end of invitation to screening: relative risk 0.80 (0.65 to 0.98) for Copenhagen and 0.67 (0.55 to 0.81) for Funen during the first four years. The relative risk of breast cancer accumulated over the entire follow-up period was 1.06 (0.90 to 1.25) for Copenhagen and 1.01 (0.93 to 1.10) for Funen. Relative risks for participants corrected for selection bias were estimated to be 1.08 for Copenhagen and 1.02 for Funen; for participants followed for at least eight years after the end of screening, they were 1.05 and 1.01. A pooled estimate gave 1.040 (0.99 to 1.09) for all targeted women and 1.023 (0.97 to 1.08) for targeted women followed for at least eight years after the end of screening.ConclusionsOn the basis of combined data from the two screening programmes, this study indicated that overdiagnosis most likely amounted to 2.3% (95% confidence interval -3% to 8%) in targeted women. Among participants, it was most likely 1-5%. At least eight years after the end of screening were needed to compensate for the excess incidence during screening.

Project description:BackgroundDecades of persuasive messages have reinforced the importance of traditional screening mammography at regular intervals. A potential new paradigm, risk-based screening, adjusts mammography frequency based on a woman's estimated breast cancer risk in order to maximize mortality reduction while minimizing false positives and overdiagnosis. Women's views of risk-based screening are unknown.ObjectiveTo explore women's views and personal acceptability of a potential risk-based mammography screening paradigm.DesignFour semi-structured focus group discussions about screening mammography and surveys before provision of information about risk-based screening. We analyzed coded focus group transcripts using a mixed deductive (content analysis) and inductive (grounded theory) approach.ParticipantsConvenience sample of 29 women (40-74 years old) with no personal history of breast cancer recruited by print and online media in New Hampshire and Vermont.ResultsTwenty-seven out of 29 women reported having undergone mammography screening. All participants were white and most were highly educated. Some women accepted the idea that early cancer detection with traditional screening was beneficial-although many also reported hearing inconsistent recommendations from clinicians and mixed messages from media reports about mammography. Some women were familiar with a risk-based screening paradigm (primarily related to cervical cancer, n = 8) and thought matching screening mammography frequency to personal risk made sense (n = 8). Personal acceptability of risk-based screening was mixed. Some believed risk-based screening could reduce the harms of false positives and overdiagnosis (n = 7). Others thought screening less often might result in missing a dangerous diagnosis (n = 14). Many (n = 18) expressed concerns about the feasibility of risk-based screening and questioned whether breast cancer risk estimates could be accurate. Some suspected that risk-based mammography was motivated by a desire to save money (n = 6).ConclusionSome women thought risk-based screening made sense. Willingness to abandon traditional screening for the new paradigm was mixed. Broad acceptability of risk-based screening will require clearer communication about its rationale and feasibility and consistent messages from the health care team.

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International variation in screening mammography interpretations in community-based programs.

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International variation in screening mammography interpretations in community-based programs.

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