Mammography in 53,803 Women from the New Hampshire Mammography Network

PURPOSE: To describe measures of mammography performance in a geographically defined population and evaluate the interpreter’s use of the Breast Imaging Reporting and Data System (BI-RADS).

MATERIALS AND METHODS: Mammographic data from 47,651 screening and 6,152 diagnostic examinations from November 1, 1996, to October 31, 1997, were linked to 1,572 pathologic results. Mammographic outcomes were based on BI-RADS assessments and recommendations reported by the interpreting radiologist. The consistency of BI-RADS recommendations was evaluated.

RESULTS: Screening mammography had a sensitivity of 72.4% (95% CI: 66.4%, 78.4%), specificity of 97.3% (95% CI: 97.25%, 97.4%), and positive predictive value of 10.6% (95% CI: 9.1%, 12.2%). Diagnostic mammography had higher sensitivity, 78.1% (95% CI: 71.9%, 84.3%); lower specificity, 89.3% (95% CI: 88.5%, 90.1%); and better positive predictive value, 17.1% (95% CI: 14.5%, 19.8%). The cancer detection rate with screening mammography was 3.3 per 1,000 women, with a biopsy yield of 22.4%, whereas the interval cancer rate was 1.2 per 1,000. Nearly 80% of screening-detected invasive malignancies were node negative. The recall rate for screening mammography was 8.3%. Ultrasonography was used in 3.5% of screening and 17.5% of diagnostic examinations. BI-RADS recommendations were generally consistent, except for probably benign assessments.

CONCLUSION: The sensitivity of screening mammography in this population-based sample is lower than expected, although other performance indicators are commendable. BI-RADS “probably benign” assessments are commonly misused.

References

  • 1 Fletcher SW, Black W, Harris R, Rimer BK, Shapiro S. Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst 1993; 85:1644-1656.
  • 2 Nystrom L, Rutqvist LE, Wall S, et al. Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet 1993; 341:973-978.
  • 3 Tabar L, Fagerberg G, Duffy SW. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am 1992; 30:187-210.
  • 4 Roberts MM, Alexander F, Anderson TJ. Edinburgh trail of screening for breast cancer: mortality at seven years. Lancet 1990; 335:241-246.
  • 5 Frisell J, Klund G, Hellstrom L. Randomized study of mammography screening: preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat 1991; 18:49-56.
  • 6 . In: Shapiro S, Venet W, Strax P., eds. Periodic screening for breast cancer. Baltimore, Md: Johns Hopkins University Press, 1988.
  • 7 Andersson I, Aspegren K, Janzon L, et al. Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. BMJ 1998; 297:943-948.
  • 8 Elwood JM, Cox B, Richardson AK. The effectiveness of breast cancer screening by mammography in younger women/RTITLE>. Online J Curr Clin Trials February 25, 1993; doc 32:.
  • 9 Kerlikowske K, Grady D, Rubin SM. Efficacy of screening mammography: a meta-analysis. JAMA 1995; 273:149-154.
  • 10 Sickles EA, Ominsky SH, Sollitto RA, Galvin HB, Monticciolo DL. Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations. Radiology 1990; 175:323-327.
  • 11 Bird RE. Low-cost screening mammography: report on finances and review of 21,716 consecutive cases. Radiology 1989; 171:87-90.
  • 12 Spring DB, Kimbrell-Wilmot K. Evaluating the success of mammography at the local level: how to conduct an audit of your practice. Radiol Clin North Am 1987; 25:983-992.
  • 13 Margolin FR, Lagios MD. Development of mammography and breast services in a community hospital. Radiol Clin North Am 1987; 25:973-982.
  • 14 . Clinical practice guideline number 13: quality determinants of mammography Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research, 1994; AHCPR publication 95-0632.
  • 15 Robertson CL. A private breast imaging practice: medical audit of 25,788 screening and 1,077 diagnostic examinations. Radiology 1993; 187:75-79.
  • 16 Wolfe JN, Buck KA, Salane M, Parekh NJ. Xeroradiography of the breast: overview of 21,057 consecutive cases. Radiology 1987; 165:305-311.
  • 17 Moseson D. Audit of mammography in a community setting. Am J Surg 1992; 163:544-546.
  • 18 Braman DM, Williams HD. ACR accredited suburban mammography center: three year results. J Fla Med Assoc 1989; 76:1031-1034.
  • 19 Brown ML, Houn F, Sickles EA, Kessler LG. Screening mammography in community practice: positive predictive value of abnormal findings and yield of follow-up diagnostic procedures. AJR Am J Roentgenol 1995; 165:1373-1377.
  • 20 Beam CA, Layde PM, Sullivan DC. Variability in the interpretation of screening mammograms by radiologists. Arch Intern Med 1996; 156:209-213.
  • 21 Rosenberg RD, Lando JF, Hunt WC, et al. The New Mexico Mammography Project: screening mammography performance in Albuquerque, New Mexico, 1991 to 1993. Cancer 1996; 78:1731-1739.
  • 22 Rosenberg RD, Hunt WC, Williamson MR, et al. Effects of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: review of 183,134 screening mammograms in Albuquerque, New Mexico. Radiology 1998; 209:511-518.
  • 23 Kopans DB, D’Orsi CJ, Adler DED, et al. Breast imaging reporting and data system 3rd ed. Reston, Va: American College of Radiology, 1998; 93-95.
  • 24 Carney PA, Poplack SP, Wells WA, et al. The New Hampshire Mammography Network: the development and design of a population-based registry. AJR Am J Roentgenol 1996; 167:367-372.
  • 25 Ballard-Barbash R, Taplin SH, Yankaskas BC, et al. Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. AJR Am J Roentgenol 1997; 169:1001-1008.
  • 26 Carney PA, Goodrich ME, O’Mahony D, et al. Mammography in New Hampshire: characteristics of the women and the exams they receive. J Community Health 2000; 25:183-198.
  • 27 Sickles EA. Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology 1991; 179:463-468.
  • 28 Varas X, Leborgne F, Leborgne JH. Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology 1992; 184:409-414.
  • 29 Begg CB, McNeil BJ. Assessment of radiologic tests: control of bias and other design considerations. Radiology 1988; 167:565-569.
  • 30 Sickles EA. Quality assurance: how to audit your own mammography practice. Radiol Clin North Am 1992; 30:265-275.
  • 31 Burhenne HJ, Burhenne LW, Goldberg F, et al. Interval breast cancers in the screening mammography program of British Columbia: analysis and classification. AJR Am J Roentgenol 1994; 162:1067-1071.
  • 32 Seidman H, Gelb SK, Silverberg E, LaVerda N, Lubera JA. Survival experience in the Breast Cancer Detection Demonstration Project. CA Cancer J Clin 1987; 37:258-290.
  • 33 Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study. I. Breast cancer detection and death rates among women aged 40 to 49 years. Can Med Assoc J 1992; 147:1459-1476.
  • 34 Miller AB, Baines CJ, To T, Wall C. Canadian National Breast Screening Study. II. Breast cancer detection and death rates among women aged 50 to 59 years. Can Med Assoc J 1992; 147:1477-1488.
  • 35 Moskowitz M. Interval breast cancers in the screening mammography program of British Columbia: commentary (editorial). AJR Am J Roentgenol 1994; 162:1072-1075.
  • 36 Kerlikowske K, Grady D, Barclay J, Sickles EA, Eaton A, Ernster V. Positive predictive value of screening mammography by age and family history of breast cancer. JAMA 1993; 270:2444-2450.
  • 37 Burhenne LW, Hislop TG, Burhenne HJ. The British Columbia Mammography Screening Program: evaluation of the first 15 months. AJR Am J Roentgenol 1992; 158:45-49.
  • 38 Linver MN, Paster SB, Rosenberg RD, Key CR, Stidley CA, King WV. Improvement in mammography interpretation skills in a community radiology practice after dedicated teaching courses: 2-year medical audit of 38,633 cases. Radiology 1992; 184:39-43.
  • 39 Morrison AS, Brisson J, Khalid N. Breast cancer incidence and mortality in the Breast Cancer Detection Demonstration Project. J Natl Cancer Inst 1988; 80:1540-1546.
  • 40 Linver MN, Osuch JR, Brenner JR, Smith RA. The mammography audit: a primer for the mammography quality standards act (MQSA). AJR Am J Roentgenol 1995; 165:19-25.
  • 41 Geller BM, Worden JK, Ashley JA, Oppenheimer RG, Weaver DL. Multipurpose statewide breast cancer surveillance system: the Vermont experience. J Registry Manage 1996; 23:168-174.
  • 42 Thompson RS, Barlow WE, Taplin SH, et al. A population-based case-cohort evaluation of the efficacy of mammographic screening for breast cancer. Am J Epidemiol 1994; 140:889-901.

Article History

Published in print: Dec 2000