© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 15, 1151-1159,
August 7, 2002
© 2002 Oxford University Press
ARTICLE |
Performance of Diagnostic Mammography for Women With Signs or Symptoms of Breast Cancer
Affiliations of authors: W. E. Barlow, Center for Health Studies, Group Health Cooperative, Department of Biostatistics, University of Washington, Seattle; C. D. Lehman, Department of Radiology, Seattle Cancer Care Alliance, University of Washington; Y. Zheng, Department of Biostatistics, University of Washington; R. Ballard-Barbash, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; B. C. Yankaskas, Department of Radiology, University of North Carolina, Chapel Hill; G. R. Cutter, Center for Research Design and Statistical Methods, University of Nevada at Reno; P. A. Carney, Norris Cotton Cancer Center/ Dartmouth-Hitchcock Medical Center/Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH; B. M. Geller, Health Promotion Research, College of Medicine, University of Vermont, Burlington; R. Rosenberg, Department of Radiology, University of New Mexico, Albuquerque; K. Kerlikowske, Department of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco; D. L. Weaver, Department of Pathology, University of Vermont, College of Medicine, Burlington; S. H. Taplin, Center for Health Studies, Group Health Cooperative, and Department of Family Medicine, University of Washington.
Correspondence to: William E. Barlow, Ph.D., Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101-1448 (e-mail: barlow.w{at}ghc.org).
Background: The performance of diagnostic mammography for women with signs or symptoms of breast cancer has not been well studied. We evaluated whether age, breast density, self-reported breast lump, and previous mammography influence the performance of diagnostic mammography. Methods: From January 1996 through March 1998, prospective diagnostic mammography data from women aged 25–89 years with no previous breast cancer were linked to cancer outcomes data in six mammography registries participating in the Breast Cancer Surveillance Consortium. We used the final mammographic assessment at the end of the imaging work-up to determine abnormal mammographic examination rate, positive predictive value (PPV), sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. We used age, breast density, prior mammogram, and self-reported breast lump jointly as predictors of performance. All statistical tests were two-sided. Results: Of 41 427 diagnostic mammograms, 6279 (15.2%) were judged abnormal. The overall PPV was 21.8%, sensitivity was 85.8%, and specificity was 87.7%. Multivariate analysis showed that sensitivity and specificity generally declined as breast density increased (P = .007 and P<.001, respectively), that previous mammography decreased sensitivity (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.36 to 0.74; P<.001) but increased specificity (OR = 1.43, 95% CI = 1.31 to 1.57; P<.001), and that a self-reported breast lump increased sensitivity (OR = 1.64, 95% CI = 1.13 to 2.38; P = .013) but decreased specificity (OR = 0.54, 95% CI = 0.49 to 0.59; P<.001). ROC analysis showed that higher breast density and previous mammography were negatively related to accuracy (P<.001 for both). Conclusions: Diagnostic mammography in women with signs or symptoms of breast cancer shows higher sensitivity and lower specificity than screening mammography does. Higher breast density and previous mammographic examination appear to impair performance.
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