Defining menopausal status in epidemiologic studies: A comparison of multiple approaches and their effects on breast cancer rates.

Objectives: Menopausal status is a common covariate in epidemiologic studies. Still, there are no standard definitions for menopausal status using observational data. This study assesses distinctions between menopausal status definitions using commonly collected epidemiologic data, and explores their impact on study outcomes using breast cancer rates as an example.

Radiologists' attitudes and use of mammography audit reports.

Rationale And Objectives: The US Mammography Quality Standards Act mandates medical audits to track breast cancer outcomes data associated with interpretive performance. The objectives of our study were to assess the content and style of audits and examine use of, attitudes toward, and perceptions of the value that radiologists' have regarding mandated medical audits.

Materials And Methods: Radiologists (n = 364) at mammography registries in seven US states contributing data to the Breast Cancer Surveillance Consortium (BCSC) were invited to participate.

Recording of hormone therapy and breast density in breast screening programs: summary and recommendations of the International Cancer Screening Network.

Breast density and the use of hormone therapy (HT) for menopausal symptoms alter the risk of breast cancer and both factors influence screening mammography performance. The International Cancer Screening Network (ICSN) surveyed its 29 member countries and found that few programs record breast density or the use of HT among screening participants. This may affect the ability of programs to assess their effectiveness in reducing breast cancer mortality.

Identifying minimally acceptable interpretive performance criteria for screening mammography.

Purpose: To develop criteria to identify thresholds for minimally acceptable physician performance in interpreting screening mammography studies and to profile the impact that implementing these criteria may have on the practice of radiology in the United States.

Materials And Methods: In an institutional review board-approved, HIPAA-compliant study, an Angoff approach was used in two phases to set criteria for identifying minimally acceptable interpretive performance at screening mammography as measured by sensitivity, specificity, recall rate, positive predictive value (PPV) of recall (PPV(1)) and of biopsy recommendation (PPV(2)), and cancer detection rate. Performance measures were considered separately.

Modelling the cumulative risk of a false-positive screening test.

The goal of a screening test is to reduce morbidity and mortality through the early detection of disease; but the benefits of screening must be weighed against potential harms, such as false-positive (FP) results, which may lead to increased healthcare costs, patient anxiety, and other adverse outcomes associated with diagnostic follow-up procedures. Accurate estimation of the cumulative risk of an FP test after multiple screening rounds is important for program evaluation and goal setting, as well as informing individuals undergoing screening what they should expect from testing over time. Estimation of the cumulative FP risk is complicated by the existence of censoring and possible dependence of the censoring time on the event history.

Recommendation for short-interval follow-up examinations after a probably benign assessment: is clinical practice consistent with BI-RADS guidance?

Objective: American College of Radiology BI-RADS guidance suggests that women with a probably benign finding on mammography receive a management recommendation for short-interval follow-up; historically, radiologists in community practice have not consistently linked this assessment with short-interval follow-up. We evaluated predictors of discordance between probably benign assessments and short-interval follow-up recommendations.

Materials And Methods: We linked data on 196 radiologists who completed a survey on demographic and practice patterns to 15,515 diagnostic mammograms they interpreted with probably benign assessments between 2001 and 2006.

Performance of diagnostic mammography differs in the United States and Denmark.

Diagnostic mammography is the primary imaging modality to diagnose breast cancer. However, few studies have evaluated variability in diagnostic mammography performance in communities, and none has done so between countries. We compared diagnostic mammography performance in community-based settings in the United States and Denmark.

Bayesian Calibration of Microsimulation Models.

Microsimulation models that describe disease processes synthesize information from multiple sources and can be used to estimate the effects of screening and treatment on cancer incidence and mortality at a population level. These models are characterized by simulation of individual event histories for an idealized population of interest. Microsimulation models are complex and invariably include parameters that are not well informed by existing data.

Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.

Background: Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past 2 decades. Even though CT is associated with substantially higher radiation exposure than conventional radiography, typical doses are not known. We sought to estimate the radiation dose associated with common CT studies in clinical practice and quantify the potential cancer risk associated with these examinations.

Rates of atypical ductal hyperplasia have declined with less use of postmenopausal hormone treatment: findings from the Breast Cancer Surveillance Consortium.

Aim: To examine risk factors and rates of atypical ductal hyperplasia (ADH) with and without associated breast cancer over time and tumor characteristics of breast cancer with and without associated ADH in women previously screened with mammography.

Methods: Data on screening mammograms done between 1996 and 2005 were collected from mammography registries that participate in the Breast Cancer Surveillance Consortium. Associations between age, family history of breast cancer, postmenopausal hormone treatment (HT), and final pathology result (ADH or cancer with or without ADH in the same breast) were examined.

When is electrical cortical stimulation more likely to produce afterdischarges?

Objective: To study when afterdischarges (ADs) are more likely to occur during cortical stimulation.

Methods: We examined 6250 electrical stimulation trials in 13 patients with subdural electrodes, studying whether AD occurrence during a trial was influenced by electrode pair stimulated or AD occurrence during the previous trial. In total 545 electrodes were stimulated, 119 frontal (pre-perirolandic), 289 perirolandic, 36 parietal (post-perirolandic), 95 temporal, and 6 occipital.

Variability in interpretive performance at screening mammography and radiologists' characteristics associated with accuracy.

Purpose: To identify radiologists' characteristics associated with interpretive performance in screening mammography.

Materials And Methods: The study was approved by institutional review boards of University of Washington (Seattle, Wash) and institutions at seven Breast Cancer Surveillance Consortium sites, informed consent was obtained, and procedures were HIPAA compliant. Radiologists who interpreted mammograms in seven U.

When radiologists perform best: the learning curve in screening mammogram interpretation.

Purpose: To examine changes in screening mammogram interpretation as radiologists with and radiologists without fellowship training in breast imaging gain clinical experience.

Materials And Methods: In an institutional review board-approved HIPAA-compliant study, the performance of 231 radiologists who interpreted screen-film screening mammograms from 1996 to 2005 at 280 facilities that contribute data to the Breast Cancer Surveillance Consortium was examined. Radiologists' demographic data and clinical experience levels were collected by means of a mailed survey.

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

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.

Disclosing harmful mammography errors to patients.

Purpose: To assess radiologists' attitudes about disclosing errors to patients by using a survey with a vignette involving an error interpreting a patient's mammogram, leading to a delayed cancer diagnosis.

Materials And Methods: We conducted an institutional review board-approved survey of 364 radiologists at seven geographically distinct Breast Cancer Surveillance Consortium sites that interpreted mammograms from 2005 to 2006. Radiologists received a vignette in which comparison screening mammograms were placed in the wrong order, leading a radiologist to conclude calcifications were decreasing in number when they were actually increasing, delaying a cancer diagnosis.

Bias associated with self-report of prior screening mammography.

Background: Self-reported screening behaviors from national surveys often overestimate screening use, and the amount of overestimation may vary by demographic characteristics. We examine self-report bias in mammography screening rates overall, by age, and by race/ethnicity.

Methods: We use mammography registry data (1999-2000) from the Breast Cancer Surveillance Consortium to estimate the validity of self-reported mammography screening collected by two national surveys.

An assessment of the likelihood, frequency, and content of verbal communication between radiologists and women receiving screening and diagnostic mammography.

Rationale And Objectives: Research on communication between radiologists and women undergoing screening and diagnostic mammography is limited. We describe community radiologists' communication practices with patients regarding screening and diagnostic mammogram results and factors associated with frequency of communication.

Materials And Methods: We received surveys from 257 radiologists (70% of those eligible) about the extent to which they talk to women as part of their health care visit for either screening or diagnostic mammograms, whether this occurs if the exam assessment is positive or negative, and how they use estimates of patient risk to convey information about an abnormal exam where the specific finding of cancer is not yet known.

Randomized trial of therapeutic massage for chronic neck pain.

Objectives: Little is known about the effectiveness of therapeutic massage, one of the most popular complementary medical treatments for neck pain. A randomized controlled trial was conducted to evaluate whether therapeutic massage is more beneficial than a self-care book for patients with chronic neck pain.

Methods: Sixty-four such patients were randomized to receive up to 10 massages over 10 weeks or a self-care book.

Accuracy of self-reported breast cancer among women undergoing mammography.

This study estimated the sensitivity and specificity of self-reported breast cancer and their associations with patient factors and pathologic findings using data from the Breast Cancer Surveillance Consortium. We included 24,631 women with and 463,804 women without a prior diagnosis of breast cancer who completed a questionnaire (including breast cancer history) at participating US mammography facilities between 1996 and 2006. We determined "true" cancer status using cancer registries and pathology databases.

Radiologists' performance and their enjoyment of interpreting screening mammograms.

Objective: One might speculate that radiologists who enjoy mammography may exhibit better performance than radiologists who do not.

Materials And Methods: One hundred thirty-one radiologists at three Breast Cancer Surveillance Consortium (BCSC) registries completed a survey about their characteristics, clinical practices, and attitudes related to screening mammography. Survey results were linked with BCSC performance data for 662,084 screening and 33,977 diagnostic mammograms.

Predictors of radiologists' perceived risk of malpractice lawsuits in breast imaging.

Objective: The shortage of radiologists in breast imaging may be related to heightened malpractice lawsuit concerns. Our objective was to examine radiologists' reported experiences and perceptions of future lawsuit risk and explore personal and professional factors that may be associated with elevated perceptions of risk.

Materials And Methods: Radiologists who routinely interpret mammography examinations in diverse regions of the United States (Washington, Colorado, and New Hampshire) completed a mailed survey in 2002 and 2006, including questions on demographics, practice characteristics, and medicolegal experience and perceptions as well as a validated scale measuring reactions to uncertainty in clinical situations.

Statistical approaches for modeling radiologists' interpretive performance.

Although much research has been conducted to understand the influence of interpretive volume on radiologists' performance of mammography interpretation, the published literature has been unable to achieve consensus on the volume standards required for optimal mammography accuracy. One potential contributing factor is that studies have used different statistical approaches to address the same underlying scientific question. Such studies have relied on multiple mammography interpretations from a sample of radiologists; thus, an important statistical issue is appropriately accounting for dependence, or correlation, among interpretations made by (or clustered within) the same radiologist.

Statin use and female reproductive organ cancer risk in a large population-based setting.

Objective: Statins are an effective and commonly used cholesterol-lowering medication class, but their hypothesized effects on cancer risk remain uncertain. We evaluated the association between statin use and endometrial as well as ovarian cancer risks.

Methods: We conducted a retrospective study with two cohorts of women aged 45-89 years during 1990-2004 within an integrated healthcare delivery system.

Obesity, mammography use and accuracy, and advanced breast cancer risk.

Background: Being overweight or obese is associated with increased breast cancer risk and disease severity among postmenopausal women, but whether extent of mammography use and accuracy modify this association and further contribute to increases in disease severity at diagnosis among overweight and obese women is unclear.

Methods: We prospectively collected data during 1996-2005 on 287,115 postmenopausal women not using hormone therapy (HT) who underwent 614,562 mammography examinations; 4,446 women were diagnosed with breast cancer within 12 months of a mammography examination. We calculated rates per 1,000 mammography examinations of large (>15 mm), advanced-stage (IIb, III, or IV), high-grade (3 or 4), estrogen receptor (ER)-positive and -negative, and screen-detected and non-screen-detected breast cancer across body mass index (BMI, kg/m(2)) groups defined as normal (18.

Rising use of diagnostic medical imaging in a large integrated health system.

Little has been published characterizing specific patterns of the dramatic rise in diagnostic imaging during the past decade. In a large health plan, 377,048 patients underwent 4.9 million diagnostic tests from 1997 through 2006.