Abstract
Background
The accuracy of mammography reading varies among radiologists. We conducted a population-based assessment on radiologist variation in false- positive rates of screening mammography and its associated radiologist characteristics.
Methods
About 27,394 screening mammograms interpreted by 1067 radiologists were identified from a 5% non-cancer sample of Medicare claims during 1998–1999. The data were linked to the American Medical Association Masterfile to obtain radiologist characteristics. Multilevel logistic regression models were used to examine the radiologist variation in false-positive rates of screening mammography and the associated radiologist characteristics.
Results
Radiologists varied substantially in the false-positive rates of screening mammography (ranging from 1.5 to 24.1%, adjusting for patient characteristics). A longer time period since graduation is associated with lower false-positive rates (odds ratio [OR] for every 10 years increase: 0.87, 95% Confidence Interval [CI], 0.81–0.94) and female radiologists had higher false-positive rates than male radiologists (OR = 1.25, 95% CI, 1.05–1.49), adjusting for patient and other radiologist characteristics. The unmeasured factors contributed to about 90% of the between-radiologist variance.
Conclusions
Radiologists varied greatly in accuracy of mammography reading. Female and more recently trained radiologists had higher false-positive rates. The variation among radiologists was largely due to unmeasured factors, especially unmeasured radiologist factors. If our results are confirmed in further studies, they suggest that system-level interventions would be required to reduce variation in mammography interpretation.
Similar content being viewed by others
References
Breen N, Wagener DK, Brown ML et’al (2001) Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst 93(22):1704–1703
BRFSS (2005) http://apps.nccd.cdc.gov/brfss/Trends/agechart.asp?qkey=10060&state=US. Cited Jan. 21, 2005
Randolph WM, Goodwin JS, Mahnken JD et’al (2002) Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis. Ann Intern Med 137(10):783–790
McCarthy EP, Burns RB, Coughlin SS et’al (1998) Mammography use helps to explain differences in breast cancer stage at diagnosis between older black and white women. Ann Intern Med 128(9):729–736
Kerlikowske K, Grady D, Rubin SM et’al (1995) Efficacy of screening mammography. A meta-analysis. JAMA 273(2):149–154
Randall T (1993) Varied mammogram readings worry researchers. JAMA 269(20):2616–2617
Elmore JG, Barton MB, Moceri VM et’al (1998) Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med 338(16):1089–1096
Gram IT, Slenker SE (1992) Cancer anxiety and attitudes toward mammography among screening attenders, nonattenders, and women never invited. Am J Public Health 82(2):249–251
Lerman C, Trock B, Rimer BK et’al (1991) Psychological and behavioral implications of abnormal mammograms. Ann Intern Med 114(8):657–661
Velanovich V (1995) Immediate biopsy versus observation for abnormal findings on mammograms: an analysis of potential outcomes and costs. Am J Surg 170(4):327–332
Barton MB, Moore S, Polk S et’al (2001) Increased patient concern after false-positive mammograms: clinician documentation and subsequent ambulatory visits. J Gen Intern Med 16(3):150–156
Smith-Bindman R, Chu PW, Miglioretti DL et’al (2003) Comparison of screening mammography in the United States and the United kingdom. JAMA 290(16):2129–2137
Kerlikowske K, Grady D, Barclay J et’al (1993) Positive predictive value of screening mammography by age and family history of breast cancer. JAMA 270(20):2444–2450
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(3):168–175
Feldman J, Smith RA, Giusti R et’al (1995) Peer review of mammography interpretations in a breast cancer screening program. Am J Public Health 85(6):837–839
Beam CA, Layde PM, Sullivan DC (1996) Variability in the interpretation of screening mammograms by US radiologists. Findings from a national sample. Arch Intern Med 156(2):209–213
Kerlikowske K, Grady D, Barclay J et’al (1998) Variability and accuracy in mammographic interpretation using the American College of Radiology Breast Imaging Reporting and Data System. J Natl Cancer Inst 90(23):1801–1809
Rutter CM, Taplin S (2000) Assessing mammographers’ accuracy. A comparison of clinical and test performance. J Clin Epidemiol 53(5):443–450
Elmore JG, Miglioretti DL, Reisch LM et’al (2002) Screening mammograms by community radiologists: variability in false-positive rates. J Natl Cancer Inst 94(18):1373–1380
Barlow WE, Chi C, Carney PA et’al (2004) Accuracy of screening mammography interpretation by characteristics of radiologists. J Natl Cancer Inst 96(24):1840–1850
Smith-Bindman R, Chu P, Miglioretti DL et’al (2005) Physician predictors of mammographic accuracy. J Natl Cancer Inst 97(5):358–367
Warren JL, Klabunde CN, Schrag D et’al (2002) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40(8 Suppl):IV-3–18
Freeman JL, Zhang D, Freeman DH et’al (2000) An approach to identifying incident breast cancer cases using Medicare claims data. J Clin Epidemiol 53(6):605–614
Baldwin LM, Adamache W, Klabunde CN et’al (2002) Linking physician characteristics and medicare claims data: issues in data availability, quality, and measurement. Med Care 40(8 Suppl):IV-82–95
Freeman JL, Klabunde CN, Schussler N et’al (2002) Measuring breast, colorectal, and prostate cancer screening with medicare claims data. Med Care 40(8 Suppl):IV-36–42
Bach PB, Guadagnoli E, Schrag D et’al (2002) Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations. Med Care 40(8 Suppl):IV-19–25
Ash AS, Shwartz M, Pekoz EA (2003) In Risk adjustment for measuring health care outcomes, 3rd edn. (Iezzoni LI (ed), Health Administration Press, Chicago, Illinois
Raudenbush SW, Bryk AS (2002) Hierarchical linear models: applications and data analysis methods, 2nd edn. Sage Publications, Thousand Oaks, California
Christiansen CL, Morris CN (1997) Improving the statistical approach to health care provider profiling. Ann Intern Med 127(8 Pt 2):764–768
Choudhry NK, Fletcher RH, Soumerai SB (2005) Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med 142(4):260–273
Christiansen CL, Wang F, Barton MB et’al (2000) Predicting the cumulative risk of false-positive mammograms. J Natl Cancer Inst 92(20):1657–1666
Blustein J (1995) Medicare coverage, supplemental insurance, and the use of mammography by older women. N Engl J Med 332(17):1138–1143
Office of Technology Assessment (November 1987) Breast Cancer Screening for Medicare Beneficiaries: Effectiveness, Cist to Medicare and Medical Resources Required., U.S. Congress, Office of Technology Assessment, Health program
Randolph WM, Mahnken JD, Goodwin JS et’al (2002) Using Medicare data to estimate the prevalence of breast cancer screening in older women: comparison of different methods to identify screening mammograms. Health Serv Res 37(6): 1643–1657
Mouchawar J, Byers T, Warren M et’al (2004) The sensitivity of Medicare billing claims data for monitoring mammography use by elderly women. Med Care Res Rev 61(1):116–127
BI-RADS (2003) BI-RADS®—Mammography, American College of Radiology, Reston, VA
Taplin SH, Ichikawa LE, Kerlikowske K et’al (2002) Concordance of breast imaging reporting and data system assessments and management recommendations in screening mammography. Radiology 222(2):529–535
Moseson D, Meharg K (1994) Tumor registry audit of mammography in community practice. Am J Surg 167(5):505–508
Rosenberg RD, Lando JF, Hunt WC et’al (1996) The New Mexico Mammography Project. Screening mammography performance in Albuquerque, New Mexico, 1991 to 1993. Cancer 78(8):1731–1739
Gill KS, Yankaskas BC (2004) Screening mammography performance and cancer detection among black women and white women in community practice. Cancer 100(1):139–148
Acknowledgements
This study is supported by grants from National Cancer Institute, National Institutes of Health (R01CA072076 and P50CA105631) and the Agency for Healthcare Research and Quality (R24HS011618). The study used the linked SEER-Medicare Database. The interpretations and reporting of the data are the sole responsibility of the authors. The authors acknowledge the efforts of: the Applied Research Branch, Division of Cancer Prevention and Population Science, NCI; the Office of Information Services, and the Office of Strategic Planning, HCFA; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tan, A., Freeman, D.H., Goodwin, J.S. et al. Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment. Breast Cancer Res Treat 100, 309–318 (2006). https://doi.org/10.1007/s10549-006-9252-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-006-9252-6