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

Andrea J. Cook, Joann G. Elmore, Diana L Miglioretti, Edward A. Sickles, Erin J. Aiello Bowles, Gary R. Cutter, Patricia A. Carney

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: To assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics. Study Design and Setting: Screening mammograms (n = 638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries was linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression. Results: Having one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.15-1.19; ≥2 vs. 0: OR = 1.43, 95% CI = 1.40-1.47) and lower specificity (1 vs. 0: OR = 0.86 [95% CI = 0.84-0.88]; ≥2 vs. 0: OR = 0.70 [95% CI = 0.68-0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR = 1.08 [95% CI = 0.99-1.19]; ≥2 vs. 0: OR = 1.12 [95% CI = 0.99-1.26]). There was no indication that influence of risk factors varied by radiologist characteristics. Conclusion: Women with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.

Original languageEnglish (US)
Pages (from-to)441-451
Number of pages11
JournalJournal of Clinical Epidemiology
Volume63
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Mammography
Odds Ratio
Confidence Intervals
Breast Neoplasms
Family Therapy
Registries
Radiologists
Neoplasms
Logistic Models
Hormones
Biopsy

Keywords

  • Breast biopsy
  • Breast cancer screening
  • Family history
  • Hormone-replacement therapy
  • Mammography
  • Radiologist performance

ASJC Scopus subject areas

  • Epidemiology

Cite this

Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors. / Cook, Andrea J.; Elmore, Joann G.; Miglioretti, Diana L; Sickles, Edward A.; Aiello Bowles, Erin J.; Cutter, Gary R.; Carney, Patricia A.

In: Journal of Clinical Epidemiology, Vol. 63, No. 4, 04.2010, p. 441-451.

Research output: Contribution to journalArticle

Cook, Andrea J. ; Elmore, Joann G. ; Miglioretti, Diana L ; Sickles, Edward A. ; Aiello Bowles, Erin J. ; Cutter, Gary R. ; Carney, Patricia A. / Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors. In: Journal of Clinical Epidemiology. 2010 ; Vol. 63, No. 4. pp. 441-451.
@article{a752386385f24f55a659c447c1c37880,
title = "Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors",
abstract = "Objective: To assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics. Study Design and Setting: Screening mammograms (n = 638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries was linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression. Results: Having one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR] = 1.17, 95{\%} confidence interval [CI] = 1.15-1.19; ≥2 vs. 0: OR = 1.43, 95{\%} CI = 1.40-1.47) and lower specificity (1 vs. 0: OR = 0.86 [95{\%} CI = 0.84-0.88]; ≥2 vs. 0: OR = 0.70 [95{\%} CI = 0.68-0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR = 1.08 [95{\%} CI = 0.99-1.19]; ≥2 vs. 0: OR = 1.12 [95{\%} CI = 0.99-1.26]). There was no indication that influence of risk factors varied by radiologist characteristics. Conclusion: Women with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.",
keywords = "Breast biopsy, Breast cancer screening, Family history, Hormone-replacement therapy, Mammography, Radiologist performance",
author = "Cook, {Andrea J.} and Elmore, {Joann G.} and Miglioretti, {Diana L} and Sickles, {Edward A.} and {Aiello Bowles}, {Erin J.} and Cutter, {Gary R.} and Carney, {Patricia A.}",
year = "2010",
month = "4",
doi = "10.1016/j.jclinepi.2009.06.008",
language = "English (US)",
volume = "63",
pages = "441--451",
journal = "Journal of Clinical Epidemiology",
issn = "0895-4356",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Decreased accuracy in interpretation of community-based screening mammography for women with multiple clinical risk factors

AU - Cook, Andrea J.

AU - Elmore, Joann G.

AU - Miglioretti, Diana L

AU - Sickles, Edward A.

AU - Aiello Bowles, Erin J.

AU - Cutter, Gary R.

AU - Carney, Patricia A.

PY - 2010/4

Y1 - 2010/4

N2 - Objective: To assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics. Study Design and Setting: Screening mammograms (n = 638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries was linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression. Results: Having one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.15-1.19; ≥2 vs. 0: OR = 1.43, 95% CI = 1.40-1.47) and lower specificity (1 vs. 0: OR = 0.86 [95% CI = 0.84-0.88]; ≥2 vs. 0: OR = 0.70 [95% CI = 0.68-0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR = 1.08 [95% CI = 0.99-1.19]; ≥2 vs. 0: OR = 1.12 [95% CI = 0.99-1.26]). There was no indication that influence of risk factors varied by radiologist characteristics. Conclusion: Women with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.

AB - Objective: To assess the impact of women's breast cancer risk factors (use of hormone therapy, family history of breast cancer, previous breast biopsy) on radiologists' mammographic interpretive performance and whether the influence of risk factors varies according to radiologist characteristics. Study Design and Setting: Screening mammograms (n = 638,947) performed from 1996 to 2005 by 134 radiologists from three Breast Cancer Surveillance Consortium registries was linked to cancer outcomes, radiologist surveys, and patient questionnaires. Interpretive performance measures were modeled using marginal and conditional logistic regression. Results: Having one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.15-1.19; ≥2 vs. 0: OR = 1.43, 95% CI = 1.40-1.47) and lower specificity (1 vs. 0: OR = 0.86 [95% CI = 0.84-0.88]; ≥2 vs. 0: OR = 0.70 [95% CI = 0.68-0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR = 1.08 [95% CI = 0.99-1.19]; ≥2 vs. 0: OR = 1.12 [95% CI = 0.99-1.26]). There was no indication that influence of risk factors varied by radiologist characteristics. Conclusion: Women with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.

KW - Breast biopsy

KW - Breast cancer screening

KW - Family history

KW - Hormone-replacement therapy

KW - Mammography

KW - Radiologist performance

UR - http://www.scopus.com/inward/record.url?scp=77549085616&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77549085616&partnerID=8YFLogxK

U2 - 10.1016/j.jclinepi.2009.06.008

DO - 10.1016/j.jclinepi.2009.06.008

M3 - Article

C2 - 19744825

AN - SCOPUS:77549085616

VL - 63

SP - 441

EP - 451

JO - Journal of Clinical Epidemiology

JF - Journal of Clinical Epidemiology

SN - 0895-4356

IS - 4

ER -