Correlation Between Screening Mammography Interpretive Performance on a Test Set and Performance in Clinical Practice.

Rationale And Objectives: Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set.

Materials And Methods: This institutional review board-approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later.

Characterizing the Mammography Technologist Workforce in North Carolina.

Purpose: Mammography technologists' level of training, years of experience, and feedback on technique may play an important role in the breast-cancer screening process. However, information on the mammography technologist workforce is scant.

Methods: In 2013, we conducted a survey mailed to 912 mammography technologists working in 224 facilities certified by the Mammography Quality Standards Act in North Carolina.

Do mammographic technologists affect radiologists' diagnostic mammography interpretative performance?

Objective: The purpose of this study was to determine whether the technologist has an effect on the radiologists' interpretative performance of diagnostic mammography.

Materials And Methods: Using data from a community-based mammography registry from 1994 to 2009, we identified 162,755 diagnostic mammograms interpreted by 286 radiologists and performed by 303 mammographic technologists. We calculated sensitivity, false-positive rate, and positive predictive value (PPV) of the recommendation for biopsy from mammography for examinations performed (i.

The influence of mammographic technologists on radiologists' ability to interpret screening mammograms in community practice.

Rationale And Objectives: To determine whether the mammographic technologist has an effect on the radiologists' interpretative performance of screening mammography in community practice.

Materials And Methods: In this institutional review board-approved retrospective cohort study, we included Carolina Mammography Registry data from 372 radiologists and 356 mammographic technologists from 1994 to 2009 who performed 1,003,276 screening mammograms. Measures of interpretative performance (recall rate, sensitivity, specificity, positive predictive value [PPV1], and cancer detection rate [CDR]) were ascertained prospectively with cancer outcomes collected from the state cancer registry and pathology reports.

Breast MRI BI-RADS assessments and abnormal interpretation rates by clinical indication in US community practices.

Rationale And Objectives: As breast magnetic resonance imaging (MRI) use grows, benchmark performance parameters are needed for auditing and quality assurance purposes. We describe the variation in breast MRI abnormal interpretation rates (AIRs) by clinical indication among a large sample of US community practices.

Materials And Methods: We analyzed data from 41 facilities across five Breast Cancer Surveillance Consortium imaging registries.

Effect of radiologists' diagnostic work-up volume on interpretive performance.

Purpose: To examine radiologists' screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists.

Materials And Methods: In an institutional review board-approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [ FPR false-positive rate ], and cancer detection rate [ CDR cancer detection rate ]). Logistic regression was used to assess the association between the volume of recalled screening mammograms ("own" mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and "any" mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up.

Educational interventions to improve screening mammography interpretation: a randomized controlled trial.

Objective: The objective of our study was to conduct a randomized controlled trial of educational interventions that were created to improve performance of screening mammography interpretation.

Materials And Methods: We randomly assigned physicians who interpret mammography to one of three groups: self-paced DVD, live expert-led educational seminar, or control. The DVD and seminar interventions used mammography cases of varying difficulty and provided associated teaching points.

Patterns of breast magnetic resonance imaging use in community practice.

Importance: Breast magnetic resonance imaging (MRI) is increasingly used for breast cancer screening, diagnostic evaluation, and surveillance. However, we lack data on national patterns of breast MRI use in community practice.

Objective: To describe patterns of breast MRI use in US community practice during the period 2005 through 2009.

Competing risks analysis in mortality estimation for breast cancer patients from independent risk groups.

This study quantifies breast cancer mortality in the presence of competing risks for complex patients. Breast cancer behaves differently in different patient populations, which can have significant implications for patient survival; hence these differences must be considered when making screening and treatment decisions. Mortality estimation for breast cancer patients has been a significant research question.

Feasibility and acceptability of conducting a randomized clinical trial designed to improve interpretation of screening mammography.

Purpose: To describe recruitment, enrollment, and participation in a study of US radiologists invited to participate in a randomized controlled trial of two continuing medical education (CME) interventions designed to improve interpretation of screening mammography.

Methods: We collected recruitment, consent, and intervention-completion information as part of a large study involving radiologists in California, Oregon, Washington, New Mexico, New Hampshire, North Carolina, and Vermont. Consenting radiologists were randomized to receive either a 1-day live, expert-led educational session; to receive a self-paced DVD with similar content; or to a control group (delayed intervention).

Association between mammographic density and basal-like and luminal A breast cancer subtypes.

Introduction: Mammographic density is a strong risk factor for breast cancer overall, but few studies have examined the association between mammographic density and specific subtypes of breast cancer, especially aggressive basal-like breast cancers. Because basal-like breast cancers are less frequently screen-detected, it is important to understand how mammographic density relates to risk of basal-like breast cancer.

Methods: We estimated associations between mammographic density and breast cancer risk according to breast cancer subtype.

Establishing a gold standard for test sets: variation in interpretive agreement of expert mammographers.

Rationale And Objectives: Test sets for assessing and improving radiologic image interpretation have been used for decades and typically evaluate performance relative to gold standard interpretations by experts. To assess test sets for screening mammography, a gold standard for whether a woman should be recalled for additional workup is needed, given that interval cancers may be occult on mammography and some findings ultimately determined to be benign require additional imaging to determine if biopsy is warranted. Using experts to set a gold standard assumes little variation occurs in their interpretations, but this has not been explicitly studied in mammography.

Reported mammographic density: film-screen versus digital acquisition.

Purpose: To test the hypothesis that American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories for breast density reported by radiologists are lower when digital mammography is used than those reported when film-screen (FS) mammography is used.

Materials And Methods: This study was institutional review board approved and HIPAA compliant. Demographic data, risk factors, and BI-RADS breast density categories were collected from five mammography registries that were part of the Breast Cancer Surveillance Consortium.

The association of breast density with breast cancer mortality in African American and white women screened in community practice.

The effect of breast density on survival outcomes for American women who participate in screening remains unknown. We studied the role of breast density on both breast cancer and other cause of mortality in screened women. Data for women with breast cancer, identified from the community-based Carolina Mammography Registry, were linked with the North Carolina cancer registry and NC death tapes for this study.

Mammographic density and breast cancer risk in White and African American Women.

Mammographic density is a strong risk factor for breast cancer, but limited data are available in African American (AA) women. We examined the association between mammographic density and breast cancer risk in AA and white women. Cases (n = 491) and controls (n = 528) were from the Carolina Breast Cancer Study (CBCS) who also had mammograms recorded in the Carolina Mammography Registry (CMR).

Factors facilitating acceptable mammography services for women with disabilities.

Background: Prior research has described general barriers to breast cancer screening for women with disabilities (WWD). We explored specific accommodations described as necessary by WWD who have accessed screening services, and the presence of such accommodations in community-based screening programs.

Methods: We surveyed WWD in the Carolina Mammography Registry to determine what accommodations were needed when accessing breast screening services, and whether or not these needs were met.

Risk of advanced-stage breast cancer among older women with comorbidities.

Background: Comorbidities have been suggested influencing mammography use and breast cancer stage at diagnosis. We compared mammography use, and overall and advanced-stage breast cancer rates, among female Medicare beneficiaries with different levels of comorbidity.

Methods: We used linked Breast Cancer Surveillance Consortium (BCSC) and Medicare claims data from 1998 through 2006 to ascertain comorbidities among 149,045 female Medicare beneficiaries ages 67 and older who had mammography.

Impact of an educational intervention designed to reduce unnecessary recall during screening mammography.

Rationale And Objectives: The aim of this study was to describe the impact of a tailored Web-based educational program designed to reduce excessive screening mammography recall.

Materials And Methods: Radiologists enrolled in one of four mammography registries in the United States were invited to take part and were randomly assigned to receive the intervention or to serve as controls. The controls were offered the intervention at the end of the study, and data collection included an assessment of their clinical practice as well.

Association between time spent interpreting, level of confidence, and accuracy of screening mammography.

Objective: The objective of this study was to examine the effect of time spent viewing images and level of confidence on a screening mammography test set on interpretive performance.

Materials And Methods: Radiologists from six mammography registries participated in this study and were randomized to interpret one of four test sets and complete 12 survey questions. Each test set had 109 cases of digitized four-view screening screen-film mammograms with prior comparison screening views.

Mammographic interpretive volume and diagnostic mammogram interpretation performance in community practice.

Purpose: To investigate the association between radiologist interpretive volume and diagnostic mammography performance in community-based settings.

Materials And Methods: This study received institutional review board approval and was HIPAA compliant. A total of 117,136 diagnostic mammograms that were interpreted by 107 radiologists between 2002 and 2006 in the Breast Cancer Surveillance Consortium were included.

Effect of observing change from comparison mammograms on performance of screening mammography in a large community-based population.

Purpose: To 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 Methods: This 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.

Comparative effectiveness of digital versus film-screen mammography in community practice in the United States: a cohort study.

Background: Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice.

Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study.

Background: False-positive mammography results are common. Biennial screening may decrease the cumulative probability of false-positive results across many years of repeated screening but could also delay cancer diagnosis.

Objective: To compare the cumulative probability of false-positive results and the stage distribution of incident breast cancer after 10 years of annual or biennial screening mammography.

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

Purpose: To examine whether U.S. radiologists' interpretive volume affects their screening mammography performance.

Using a tailored web-based intervention to set goals to reduce unnecessary recall.

Rationale And Objectives: To examine whether an intervention strategy consisting of a tailored web-based intervention, which provides individualized audit data with peer comparisons and other data that can affect recall, can assist radiologists in setting goals for reducing unnecessary recall.

Materials And Methods: In a multisite randomized controlled study, we used a tailored web-based intervention to assess radiologists' ability to set goals to improve interpretive performance. The intervention provided peer comparison audit data, profiled breast cancer risk in each radiologist's respective patient populations, and evaluated the possible impact of medical malpractice concerns.