Effect of radiologist experience on the risk of false-positive results in breast cancer screening programs
- Alberdi, Raquel Zubizarreta 1
- Llanes, Ana B. Fernández 1
- Ortega, Raquel Almazán 1
- Expósito, Rubén Roman 2
- Collado, Jose M. Velarde 2
- Verdes, Teresa Queiro 3
- Ramos, Carmen Natal 4
- Sanz, María Ederra 5
- Trejo, Dolores Salas 6
- Oliveres, Xavier Castells 2
- 1 Galician Breast Cancer Screening Programme, Public Health and Planning Directorate, Health Office, Galicia, Spain
- 2 Institut Municipal d'Investigació Mèdica-Parc de Salut Mar. CIBERESP, Department of Epidemiology and Evaluation, Barcelona, Spain
- 3 Galician Agency for Health Technology Assessment, Public Health and Planning Directorate, Health Office, Galicia, Spain
- 4 Principality of Asturias Breast Cancer Screening Programme, Principality of Asturias, Spain
- 5 Navarra Breast Cancer Screening Programme, Public Health Institute, Pamplona, Spain
- 6 Valencia Breast Cancer Screening Programme, General Directorate Public Health, Centre for Public Health Research (CSISP), Valencia, Spain
ISSN: 0938-7994, 1432-1084
Year of publication: 2011
Volume: 21
Issue: 10
Pages: 2083-2090
Type: Article
More publications in: European Radiology
Sustainable development goals
Abstract
Objectives: To evaluate the effect of radiologist experience on the risk of false-positive results in population-based breast cancer screening programmes. Methods: We evaluated 1,440,384 single-read screening mammograms, corresponding to 471,112 women aged 45-69 years participating in four Spanish programmes between 1990 and 2006. The mammograms were interpreted by 72 radiologists. Results: The overall percentage of false-positive results was 5.85% and that for false-positives resulting in an invasive procedure was 0.38%. Both the risk of false-positives overall and of false-positives leading to an invasive procedure significantly decreased (p<0.001) with greater reading volume in the previous year: OR 0.77 and OR 0.78, respectively, for a reading volume 500-1,999 mammograms and OR 0.59 and OR 0.60 for a reading volume of >14,999 mammograms with respect to the reference category (<500). The risk of both categories of false-positives was also significantly reduced (p<0.001) as radiologists' years of experience increased: OR 0.96 and OR 0.84, respectively, for 1 year's experience and OR 0.72 and OR 0.73, respectively, for more than 4 years' experience with regard to the category of <1 year's experience. Conclusion: Radiologist experience is a determining factor in the risk of a false-positive result in breast cancer screening.
Bibliographic References
- Deck W, Kakuma R (2006) Screening mammography: a reassessment. Montréal (Canada): Agence d’Évaluation des Technologies et des Modes d’Intervention en Santé (AETMIS). Available via http://collections.banq.qc.ca/ark:/52327/bs57227 . Accessed 14 May 2011
- Gotzsche PC, Nielsen M (2009) Screening for breast cancer with mammography. Cochrane Database Syst Rev 1:CD001877. doi: 10.1002/14651858.CD001877.pub4
- Nystrom L, Andersson I, Bjurstam N, Frisell J, Nordenskjold B, Rutqvist LE (2002) Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet 359:909–919
- von Karsa L, Anttila A, Ronco G, et al (2008) Cancer screening in the European Union. Report on the Implementation of the Council Recommendation on cancer screening—First Report. European Commission (2008). Available via http://ec.europa.eu/health/ph_determinants/genetics/documents/cancer_screening.pdf . Accessed 25 Nov 2009
- Elmore JG, Barton MB, Moceri VM, Polk S, Arena PJ, Fletcher SW (1998) Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med 338:1089–1096
- Hofvind S, Thoresen S, Tretli S (2004) The cumulative risk of a false-positive recall in the Norwegian Breast Cancer Screening Program. Cancer 101:1501–1507
- Council of the European Union (2003) Council Recommendation of 2 December 2003 on Cancer Screening (2003/878/EC) Off J Eur Union. 16 Dic 327:34–38
- Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V (1996) Effect of age, breast density, and family history on the sensitivity of first screening mammography. JAMA 276:33–38
- Carney PA, Miglioretti DL, Yankaskas BC et al (2003) Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med 138:168–175
- Lehman CD, White E, Peacock S, Drucker MJ, Urban N (1999) Effect of age and breast density on screening mammograms with false-positive findings. AJR Am J Roentgenol 173:1651–1655
- Taplin S, Abraham L, Barlow WE et al (2008) Mammography facility characteristics associated with interpretive accuracy of screening mammography. J Natl Cancer Inst 100:876–887
- Smith-Bindman R, Chu P, Miglioretti DL et al (2005) Physician predictors of mammographic accuracy. J Natl Cancer Inst 97:358–367
- Kan L, Olivotto IA, Warren Burhenne LJ, Sickles EA, Coldman AJ (2000) Standardized abnormal interpretation and cancer detection ratios to assess reading volume and reader performance in a breast screening program. Radiology 215:563–567
- Esserman L, Cowley H, Eberle C et al (2002) Improving the accuracy of mammography: volume and outcome relationships. J Natl Cancer Inst 94:369–375
- Barlow WE, Chi C, Carney PA et al (2004) Accuracy of screening mammography interpretation by characteristics of radiologists. J Natl Cancer Inst 96:1840–1850
- Beam CA, Conant EF, Sickles EA (2003) Association of volume and volume-independent factors with accuracy in screening mammogram interpretation. J Natl Cancer Inst 95:282–290
- Molins E, Macia F, Ferrer F, Maristany MT, Castells X (2008) Association between radiologists’ experience and accuracy in interpreting screening mammograms. BMC Health Serv Res 8:91
- Castells X, Sala M, Ascunce N, Salas D, Zubizarreta RMC (2007) Descripción del cribado del cáncer en España. Proyecto DESCRIC. In: Plan de Calidad para el Sistema Nacional de Salud, ed.: Ministerio de Sanidad y Consumo. Agència d’Avaluació de Tecnologia i Recerca Mèdiques de Cataluña. Available via http://www.gencat.cat/salut/depsan/units/aatrm/pdf/in0601es.pdf . Accessed 14 May 2011
- European Commission (2006) European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. In: Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L, et al. (eds) Office for Official Publications of the European Communities, Luxembourg
- Woodard DB, Gelfand AE, Barlow WE, Elmore JG (2007) Performance assessment for radiologists interpreting screening mammography. Stat Med 26:1532–1551
- Elmore JG, Miglioretti DL, Reisch LM et al (2002) Screening mammograms by community radiologists: variability in false-positive rates. J Natl Cancer Inst 94:1373–1380
- Miglioretti DL, Smith-Bindman R, Abraham L et al (2007) Radiologist characteristics associated with interpretive performance of diagnostic mammography. J Natl Cancer Inst 19(99):1854–1863
- Tan A, Freeman DH Jr, Goodwin JS, Freeman JL (2006) Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment. Breast Cancer Res Treat 100:309–318
- Castells X, Molins E, Macia F (2006) Cumulative false positive recall rate and association with participant related factors in a population based breast cancer screening programme. J Epidemiol Community Health 60:316–321