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

Abstract 

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.

Results

Having one or more clinical risk factors was associated with higher recall rates (1 vs. 0 risk factors: odds ratio [OR]=1.17, 95% confidence interval [CI]=1.15–1.19; ≥2 vs. 0: OR=1.43, 95% CI=1.40–1.47) and lower specificity (1 vs. 0: OR=0.86 [95% CI=0.84–0.88]; ≥2 vs. 0: OR=0.70 [95% CI=0.68–0.72]) without a corresponding improvement in sensitivity and only a small increase in positive predictive value (1 vs. 0: OR=1.08 [95% CI=0.99–1.19]; ≥2 vs. 0: OR=1.12 [95% CI=0.99–1.26]). There was no indication that influence of risk factors varied by radiologist characteristics.

Conclusion

Women with clinical risk factors who undergo screening mammography are more likely recalled for false-positive evaluation without an associated increase in cancer detection. Radiologists and patients with risk factors should be aware of this increased risk of adverse screening events.

Keywords: Breast cancer screening, Mammography, Radiologist performance, Hormone-replacement therapy, Family history, Breast biopsy