Abstract
BACKGROUND: Facilities serving vulnerable women have higher false-positive rates for diagnostic mammography than facilities serving nonvulnerable women. False positives lead to anxiety, unnecessary biopsies, and higher costs. OBJECTIVE: Examine whether availability of on-site breast ultrasound or biopsy services, academic medical center affiliation, or profit status explains differences in false-positive rates. DESIGN: We examined 78,733 diagnostic mammograms performed to evaluate breast problems at Breast Cancer Surveillance Consortium facilities from 1999 to 2005. We used logistic-normal mixed effects regression to determine if adjusting for facility characteristics accounts for observed differences in false-positive rates. MEASURES: Facilities were characterized as serving vulnerable women based on the proportion of mammograms performed on racial/ethnic minorities, women with lower educational attainment, limited household income, or rural residence. RESULTS: Although the availability of on-site ultrasound and biopsy services was associated with greater odds of a false positive in most models [odds ratios (OR) ranging from 1.24 to 1.88; P<0.05], adjustment for these services did not attenuate the association between vulnerability and false-positive rates. Estimated ORs for the effect of vulnerability indexes on false-positive rates unadjusted for facility services were: lower educational attainment [OR 1.33; 95% confidence intervals (CI), 1.03-1.74]; racial/ethnic minority status (OR 1.33; 95% CI, 0.98-1.80); rural residence (OR 1.56; 95% CI, 1.26-1.92); limited household income (OR 1.38; 95% CI, 1.10-1.73). After adjustment, estimates remained relatively unchanged. CONCLUSIONS: On-site diagnostic service availability may contribute to unnecessary biopsies, but does not explain the higher diagnostic mammography false-positive rates at facilities serving vulnerable women.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 210-216 |
| Number of pages | 7 |
| Journal | Medical Care |
| Volume | 50 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2012 |
| Externally published | Yes |
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Keywords
- diagnostic
- mammography
- quality
- vulnerable populations
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
Cite this
Facility characteristics do not explain higher false-positive rates in diagnostic mammography at facilities serving vulnerable women. / Goldman, L. Elizabeth; Walker, Rod; Miglioretti, Diana L; Smith-Bindman, Rebecca; Kerlikowske, Karla.
In: Medical Care, Vol. 50, No. 3, 03.2012, p. 210-216.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Facility characteristics do not explain higher false-positive rates in diagnostic mammography at facilities serving vulnerable women
AU - Goldman, L. Elizabeth
AU - Walker, Rod
AU - Miglioretti, Diana L
AU - Smith-Bindman, Rebecca
AU - Kerlikowske, Karla
PY - 2012/3
Y1 - 2012/3
N2 - BACKGROUND: Facilities serving vulnerable women have higher false-positive rates for diagnostic mammography than facilities serving nonvulnerable women. False positives lead to anxiety, unnecessary biopsies, and higher costs. OBJECTIVE: Examine whether availability of on-site breast ultrasound or biopsy services, academic medical center affiliation, or profit status explains differences in false-positive rates. DESIGN: We examined 78,733 diagnostic mammograms performed to evaluate breast problems at Breast Cancer Surveillance Consortium facilities from 1999 to 2005. We used logistic-normal mixed effects regression to determine if adjusting for facility characteristics accounts for observed differences in false-positive rates. MEASURES: Facilities were characterized as serving vulnerable women based on the proportion of mammograms performed on racial/ethnic minorities, women with lower educational attainment, limited household income, or rural residence. RESULTS: Although the availability of on-site ultrasound and biopsy services was associated with greater odds of a false positive in most models [odds ratios (OR) ranging from 1.24 to 1.88; P<0.05], adjustment for these services did not attenuate the association between vulnerability and false-positive rates. Estimated ORs for the effect of vulnerability indexes on false-positive rates unadjusted for facility services were: lower educational attainment [OR 1.33; 95% confidence intervals (CI), 1.03-1.74]; racial/ethnic minority status (OR 1.33; 95% CI, 0.98-1.80); rural residence (OR 1.56; 95% CI, 1.26-1.92); limited household income (OR 1.38; 95% CI, 1.10-1.73). After adjustment, estimates remained relatively unchanged. CONCLUSIONS: On-site diagnostic service availability may contribute to unnecessary biopsies, but does not explain the higher diagnostic mammography false-positive rates at facilities serving vulnerable women.
AB - BACKGROUND: Facilities serving vulnerable women have higher false-positive rates for diagnostic mammography than facilities serving nonvulnerable women. False positives lead to anxiety, unnecessary biopsies, and higher costs. OBJECTIVE: Examine whether availability of on-site breast ultrasound or biopsy services, academic medical center affiliation, or profit status explains differences in false-positive rates. DESIGN: We examined 78,733 diagnostic mammograms performed to evaluate breast problems at Breast Cancer Surveillance Consortium facilities from 1999 to 2005. We used logistic-normal mixed effects regression to determine if adjusting for facility characteristics accounts for observed differences in false-positive rates. MEASURES: Facilities were characterized as serving vulnerable women based on the proportion of mammograms performed on racial/ethnic minorities, women with lower educational attainment, limited household income, or rural residence. RESULTS: Although the availability of on-site ultrasound and biopsy services was associated with greater odds of a false positive in most models [odds ratios (OR) ranging from 1.24 to 1.88; P<0.05], adjustment for these services did not attenuate the association between vulnerability and false-positive rates. Estimated ORs for the effect of vulnerability indexes on false-positive rates unadjusted for facility services were: lower educational attainment [OR 1.33; 95% confidence intervals (CI), 1.03-1.74]; racial/ethnic minority status (OR 1.33; 95% CI, 0.98-1.80); rural residence (OR 1.56; 95% CI, 1.26-1.92); limited household income (OR 1.38; 95% CI, 1.10-1.73). After adjustment, estimates remained relatively unchanged. CONCLUSIONS: On-site diagnostic service availability may contribute to unnecessary biopsies, but does not explain the higher diagnostic mammography false-positive rates at facilities serving vulnerable women.
KW - diagnostic
KW - mammography
KW - quality
KW - vulnerable populations
UR - http://www.scopus.com/inward/record.url?scp=84857640644&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84857640644&partnerID=8YFLogxK
U2 - 10.1097/MLR.0b013e3182407c8a
DO - 10.1097/MLR.0b013e3182407c8a
M3 - Article
C2 - 22186768
AN - SCOPUS:84857640644
VL - 50
SP - 210
EP - 216
JO - Medical Care
JF - Medical Care
SN - 0025-7079
IS - 3
ER -