© 2003 by Oxford University Press
© 2003 Oxford University Press
ARTICLE |
International Variation in Screening Mammography Interpretations in Community-Based Programs
Affiliations of authors: J. G. Elmore, C. Y. Nakano, L. M. Desnick (Department of Medicine), T. D. Koepsell (Department of Health Services and Epidemiology), University of Washington, Seattle; C. J. D’Orsi, Department of Radiology, Emory University, Atlanta, GA; D. F. Ransohoff, Department of Medicine, University of North Carolina at Chapel Hill.
Correspondence to: J. G. Elmore, MD, MPH, Department of Medicine, Division of General Internal Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359780, Seattle, WA 98104-2499 (e-mail: jelmore{at}u.washington.edu).
Background: Variations in mammography interpretations may have important clinical and economic implications. To evaluate international variability in mammography interpretation, we analyzed published reports from community-based screening programs from around the world. Methods: A total of 32 publications were identified in MEDLINE that fit the study inclusion criteria. Data abstracted from the publications included features of the population screened, examination technique, and clinical outcomes, including the percentage of mammograms judged to be abnormal, positive predictive value of an abnormal mammogram (PPVA), positive predictive value of a biopsy performed (PPVB), and percentages of breast cancer patients with ductal carcinoma in situ (DCIS) and minimal disease (DCIS and/or tumor size 
10 mm). North American screening programs were compared with those from other countries using meta-regression analysis. All statistical tests were two-sided. Results: Wide ranges were noted for the percentage of mammograms judged to be abnormal (1.2%–15.0%), for PPVA (3.4%–48.7%), for PPVB (5.0%–85.2%), for percentage diagnosed with DCIS (4.3%–68.1%), and for percentage diagnosed with minimal disease (14.0%–80.6%). The percentage of mammograms judged to be abnormal were 2–4 percentage points higher in North American screening programs than they were in programs from other countries, after adjusting for covariates such as percentage of women who were less than 50 years of age and calendar year in which the mammogram was performed. The percentage of mammograms judged to be abnormal had a negative association with PPVA and PPVB (both P<.001) and a positive association with the frequency of DCIS cases diagnosed (P = .008) and the number of DCIS cases diagnosed per 1000 screens (P = .024); no consistent relationship was observed with the proportion of breast cancer diagnoses reported as having minimal disease or the number of minimal disease cases diagnosed per 1000 screens. Conclusion: North American screening programs appear to interpret a higher percentage of mammograms as abnormal than programs from other countries without evident benefit in the yield of cancers detected per 1000 screens, although an increase in DCIS detection was noted.
CiteULike 
Connotea 
Del.icio.us What's this?
Correspondence about this Article
- Re: International Variation in Screening Mammography Interpretations in Community-Based Programs
- Jay Onysko, Christina M. Bancej, and Carolyn P. Pim
J Natl Cancer Inst 2004 96: 238.[Extract] [Full Text] [PDF]
- RESPONSE: Re: International Variation in Screening Mammography Interpretations in Community-Based Programs
- Joann G. Elmore and David F. Ransohoff
J Natl Cancer Inst 2004 96: 238-239.[Extract] [Full Text] [PDF]
This article has been cited by other articles:
|
|
 |
|
  M. J. Schell, B. C. Yankaskas, R. Ballard-Barbash, B. F. Qaqish, W. E. Barlow, R. D. Rosenberg, and R. Smith-Bindman Evidence-based Target Recall Rates for Screening Mammography Radiology, June 1, 2007; 243(3): 681 - 689. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Jiang, D. L. Miglioretti, C. E. Metz, and R. A. Schmidt Breast Cancer Detection Rate: Designing Imaging Trials to Demonstrate Improvements Radiology, May 1, 2007; 243(2): 360 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. T. Brewer, T. Salz, and S. E. Lillie Systematic Review: The Long-Term Effects of False-Positive Mammograms Ann Intern Med, April 3, 2007; 146(7): 502 - 510. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Elmore and J. Choe Breast Cancer Screening for Women in Their 40s: Moving from Controversy about Data to Helping Individual Women Ann Intern Med, April 3, 2007; 146(7): 529 - 531. [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Fenton, J. Egger, P. A. Carney, G. Cutter, C. D'Orsi, E. A. Sickles, J. Fosse, L. Abraham, S. H. Taplin, W. Barlow, et al. Reality check: perceived versus actual performance of community mammographers. Am. J. Roentgenol., July 1, 2006; 187(1): 42 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Ganott, J. H. Sumkin, J. L. King, A. H. Klym, V. J. Catullo, C. S. Cohen, and D. Gur Screening Mammography: Do Women Prefer a Higher Recall Rate Given the Possibility of Earlier Detection of Cancer? Radiology, March 1, 2006; 238(3): 793 - 800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Coldman, D. Major, G. P. Doyle, Y. D'yachkova, N. Phillips, J. Onysko, R. Shumak, N. E. Smith, and N. Wadden Organized Breast Screening Programs in Canada: Effect of Radiologist Reading Volumes on Outcomes Radiology, March 1, 2006; 238(3): 809 - 815. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Elmore, L. M. Reisch, M. B. Barton, W. E. Barlow, S. Rolnick, E. L. Harris, L. J. Herrinton, A. M. Geiger, R. K. Beverly, G. Hart, et al. Efficacy of Breast Cancer Screening in the Community According to Risk Level J Natl Cancer Inst, July 20, 2005; 97(14): 1035 - 1043. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Elmore, S. H. Taplin, W. E. Barlow, G. R. Cutter, C. J. D'Orsi, R. E. Hendrick, L. A. Abraham, J. S. Fosse, and P. A. Carney Does Litigation Influence Medical Practice? The Influence of Community Radiologists' Medical Malpractice Perceptions and Experience on Screening Mammography Radiology, July 1, 2005; 236(1): 37 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. M. Otten, N. Karssemeijer, J. H. C. L. Hendriks, J. H. Groenewoud, J. Fracheboud, A. L. M. Verbeek, H. J. de Koning, and R. Holland Effect of Recall Rate on Earlier Screen Detection of Breast Cancers Based on the Dutch Performance Indicators J Natl Cancer Inst, May 18, 2005; 97(10): 748 - 754. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Egger, G. R. Cutter, P. A. Carney, S. H. Taplin, W. E. Barlow, R. E. Hendrick, C. J. D'Orsi, J. S. Fosse, L. Abraham, and J. G. Elmore Mammographers' Perception of Women's Breast Cancer Risk Med Decis Making, May 1, 2005; 25(3): 283 - 289. [Abstract] [PDF]
|
|
|
|
|
|
L. A. Hardesty, A. H. Klym, B. E. Shindel, D. M. Chough, J. H. Sumkin, and D. Gur Is Maximum Positive Predictive Value a Good Indicator of an Optimal Screening Mammography Practice? Am. J. Roentgenol., May 1, 2005; 184(5): 1505 - 1507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Gur, L. P. Wallace, A. H. Klym, L. A. Hardesty, G. S. Abrams, R. Shah, and J. H. Sumkin Trends in Recall, Biopsy, and Positive Biopsy Rates for Screening Mammography in an Academic Practice Radiology, May 1, 2005; 235(2): 396 - 401. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Elmore, K. Armstrong, C. D. Lehman, and S. W. Fletcher Screening for Breast Cancer JAMA, March 9, 2005; 293(10): 1245 - 1256. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Smith-Bindman, P. Chu, D. L. Miglioretti, C. Quale, R. D. Rosenberg, G. Cutter, B. Geller, P. Bacchetti, E. A. Sickles, and K. Kerlikowske Physician Predictors of Mammographic Accuracy J Natl Cancer Inst, March 2, 2005; 97(5): 358 - 367. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. C. Yankaskas, S. H. Taplin, L. Ichikawa, B. M. Geller, R. D. Rosenberg, P. A. Carney, K. Kerlikowske, R. Ballard-Barbash, G. R. Cutter, and W. E. Barlow Association between Mammography Timing and Measures of Screening Performance in the United States Radiology, February 1, 2005; 234(2): 363 - 373. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Gur, J. S. Stalder, L. A. Hardesty, B. Zheng, J. H. Sumkin, D. M. Chough, B. E. Shindel, and H. E. Rockette Computer-aided Detection Performance in Mammographic Examination of Masses: Assessment Radiology, November 1, 2004; 233(2): 418 - 423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Onysko, C. M. Bancej, and C. P. Pim Re: International Variation in Screening Mammography Interpretations in Community-Based Programs J Natl Cancer Inst, February 4, 2004; 96(3): 238 - 238. [Full Text] [PDF]
|
|
|
|
|
|
J. G. Elmore and D. F. Ransohoff RESPONSE: Re: International Variation in Screening Mammography Interpretations in Community-Based Programs J Natl Cancer Inst, February 4, 2004; 96(3): 238 - 239. [Full Text] [PDF]
|
|