Influence of annual interpretive volume on screening mammography performance in the United States

Diana S M Buist, Melissa L. Anderson, Sebastien J P A Haneuse, Edward A. Sickles, Robert A. Smith, Patricia A. Carney, Stephen H. Taplin, Robert D. Rosenberg, Berta M. Geller, Tracy L. Onega, Barbara S. Monsees, Lawrence W. Bassett, Bonnie C. Yankaskas, Joann G. Elmore, Karla Kerlikowske, Diana L Miglioretti

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Abstract

Purpose: To examine whether U.S. radiologists' interpretive volume affects their screening mammography performance. Materials and Methods: Annual interpretive volume measures (total, screening, diagnostic, and screening focus [ratio of screening to diagnostic mammograms]) were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783 965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year. BCSC registries and the Statistical Coordinating Center received institutional review board approval for active or passive consenting processes and a Federal Certificate of Confidentiality and other protections for participating women, physicians, and facilities. All procedures were compliant with the terms of the Health Insurance Portability and Accountability Act. Results: Mean sensitivity was 85.2% (95% confidence interval [CI]: 83.7%, 86.6%) and was significantly lower for radiologists with a greater screening focus (P = .023) but did not significantly differ by total (P = .47), screening (P = .33), or diagnostic (P = .23) volume. The mean false-positive rate was 9.1% (95% CI: 8.1%, 10.1%), with rates significantly higher for radiologists who had the lowest total (P = .008) and screening (P = .015) volumes. Radiologists with low diagnostic volume (P = .004 and P = .008) and a greater screening focus (P = .003 and P = .002) had significantly lower false-positive and cancer detection rates, respectively. Median invasive tumor size and proportion of cancers detected at early stages did not vary by volume. Conclusion: Increasing minimum interpretive volume requirements in the United States while adding a minimal requirement for diagnostic interpretation could reduce the number of false-positive work-ups without hindering cancer detection. These results provide detailed associations between mammography volumes and performance for policymakers to consider along with workforce, practice organization, and access issues and radiologist experience when reevaluating requirements.

Original languageEnglish (US)
Pages (from-to)72-84
Number of pages13
JournalRadiology
Volume259
Issue number1
DOIs
StatePublished - Apr 2011
Externally publishedYes

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Mammography
Neoplasms
Pyridinolcarbamate
Women Physicians
Confidence Intervals
Breast Neoplasms
Research Ethics Committees
Confidentiality
Social Responsibility
Health Insurance
Registries
Radiologists
Logistic Models
Organizations

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Buist, D. S. M., Anderson, M. L., Haneuse, S. J. P. A., Sickles, E. A., Smith, R. A., Carney, P. A., ... Miglioretti, D. L. (2011). Influence of annual interpretive volume on screening mammography performance in the United States. Radiology, 259(1), 72-84. https://doi.org/10.1148/radiol.10101698

Influence of annual interpretive volume on screening mammography performance in the United States. / Buist, Diana S M; Anderson, Melissa L.; Haneuse, Sebastien J P A; Sickles, Edward A.; Smith, Robert A.; Carney, Patricia A.; Taplin, Stephen H.; Rosenberg, Robert D.; Geller, Berta M.; Onega, Tracy L.; Monsees, Barbara S.; Bassett, Lawrence W.; Yankaskas, Bonnie C.; Elmore, Joann G.; Kerlikowske, Karla; Miglioretti, Diana L.

In: Radiology, Vol. 259, No. 1, 04.2011, p. 72-84.

Research output: Contribution to journalArticle

Buist, DSM, Anderson, ML, Haneuse, SJPA, Sickles, EA, Smith, RA, Carney, PA, Taplin, SH, Rosenberg, RD, Geller, BM, Onega, TL, Monsees, BS, Bassett, LW, Yankaskas, BC, Elmore, JG, Kerlikowske, K & Miglioretti, DL 2011, 'Influence of annual interpretive volume on screening mammography performance in the United States', Radiology, vol. 259, no. 1, pp. 72-84. https://doi.org/10.1148/radiol.10101698
Buist DSM, Anderson ML, Haneuse SJPA, Sickles EA, Smith RA, Carney PA et al. Influence of annual interpretive volume on screening mammography performance in the United States. Radiology. 2011 Apr;259(1):72-84. https://doi.org/10.1148/radiol.10101698
Buist, Diana S M ; Anderson, Melissa L. ; Haneuse, Sebastien J P A ; Sickles, Edward A. ; Smith, Robert A. ; Carney, Patricia A. ; Taplin, Stephen H. ; Rosenberg, Robert D. ; Geller, Berta M. ; Onega, Tracy L. ; Monsees, Barbara S. ; Bassett, Lawrence W. ; Yankaskas, Bonnie C. ; Elmore, Joann G. ; Kerlikowske, Karla ; Miglioretti, Diana L. / Influence of annual interpretive volume on screening mammography performance in the United States. In: Radiology. 2011 ; Vol. 259, No. 1. pp. 72-84.
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AU - Anderson, Melissa L.

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AU - Smith, Robert A.

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AU - Taplin, Stephen H.

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AU - Monsees, Barbara S.

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N2 - Purpose: To examine whether U.S. radiologists' interpretive volume affects their screening mammography performance. Materials and Methods: Annual interpretive volume measures (total, screening, diagnostic, and screening focus [ratio of screening to diagnostic mammograms]) were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783 965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year. BCSC registries and the Statistical Coordinating Center received institutional review board approval for active or passive consenting processes and a Federal Certificate of Confidentiality and other protections for participating women, physicians, and facilities. All procedures were compliant with the terms of the Health Insurance Portability and Accountability Act. Results: Mean sensitivity was 85.2% (95% confidence interval [CI]: 83.7%, 86.6%) and was significantly lower for radiologists with a greater screening focus (P = .023) but did not significantly differ by total (P = .47), screening (P = .33), or diagnostic (P = .23) volume. The mean false-positive rate was 9.1% (95% CI: 8.1%, 10.1%), with rates significantly higher for radiologists who had the lowest total (P = .008) and screening (P = .015) volumes. Radiologists with low diagnostic volume (P = .004 and P = .008) and a greater screening focus (P = .003 and P = .002) had significantly lower false-positive and cancer detection rates, respectively. Median invasive tumor size and proportion of cancers detected at early stages did not vary by volume. Conclusion: Increasing minimum interpretive volume requirements in the United States while adding a minimal requirement for diagnostic interpretation could reduce the number of false-positive work-ups without hindering cancer detection. These results provide detailed associations between mammography volumes and performance for policymakers to consider along with workforce, practice organization, and access issues and radiologist experience when reevaluating requirements.

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