International variation in screening mammography interpretations in community-based programs
| Autor: | Connie Y. Nakano, Joann G. Elmore, Thomas D. Koepsell, David F. Ransohoff, Carl J. D'Orsi, Laurel Desnick |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Cancer Research
medicine.medical_specialty International Cooperation Breast Neoplasms Article Breast cancer Predictive Value of Tests medicine Mammography Humans Mass Screening Medical physics False Positive Reactions Community Health Services Mass screening Aged Gynecology Community based Observer Variation medicine.diagnostic_test Screening mammography business.industry Incidence (epidemiology) Public health Incidence Cancer Middle Aged medicine.disease Variation (linguistics) Carcinoma Intraductal Noninfiltrating Oncology Predictive value of tests Family medicine North America Female Clinical Competence Clinical competence business Observer variation |
| Zdroj: | Journal of the National Cancer Institute. 95(18) |
| ISSN: | 1460-2105 |
| Popis: | Substantial intra- and interobserver variability has been noted among radiologists interpreting screening mammograms in research situations (1–3). This variability is similar to that seen in other areas of medicine where observation and interpretation are subjective (4,5). Several studies in the United States (6–8) have suggested that variation in mammography interpretation also exists among radiologists in community-based facilities. One review (6) of U.S. screening programs found that the percentage of screening mammograms for which additional work-up is recommended (i.e., percentage of mammograms judged to be abnormal, often referred to as the recall rate) ranged from approximately 2% to more than 50%, with an average of 11%. Another study (7) found that the positive predictive value of a biopsy performed (PPVB) (i.e., the percentage of women who were actually found to have breast cancer among those referred for biopsy following screening mammography) ranged from 17% for radiologists practicing in the community to 26% for radiologists practicing at an academic center. A recent study by Elmore et al. (8) reported that radiologists varied widely in their false-positive rates for interpretation of screening mammograms, even after controlling for patient, radiologist, and testing characteristics. Variability in screening mammography interpretations may have important clinical and economic implications. Although clinicians do not wish to miss breast cancers, it is important to minimize unnecessary follow-up diagnostic procedures, costs, and patient anxiety associated with false-positive screening mammograms. In this article, we compare published data from community-based mammography screening programs in North America with similar screening programs in other countries to address two important questions: 1) To what extent is variability in mammographic interpretation in community-based screening mammography programs observed between programs in North America and other countries? and 2) Is variability in mammographic interpretation associated with different intermediate measures of breast cancer outcome (i.e., percentage of breast cancer cases with ductal carcinoma in situ [DCIS] and/or minimal disease)? Based on our findings, we discuss possible explanations for variability in mammography interpretations and of the implications that this variability might have on future research, health policy, and patient care. |
| Databáze: | OpenAIRE |
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