@article{686b0a3c01604d27b96053be0db87490,
title = "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 biopsy, Breast cancer screening, Family history, Hormone-replacement therapy, Mammography, Radiologist performance",
author = "Cook, {Andrea J.} and Elmore, {Joann G.} and Miglioretti, {Diana L.} and Sickles, {Edward A.} and {Aiello Bowles}, {Erin J.} and Cutter, {Gary R.} and Carney, {Patricia A.}",
note = "Funding Information: This work was supported by the Agency for Healthcare Research and Quality (HS-10591) and the National Cancer Institute (1R01 CA107623; 1K05 CA104699; Breast Cancer Surveillance Consortium: U01 CA63731, U01 CA86082, U01 CA63736, and U01CA86076). The collection of cancer incidence data used in this study was supported, in part, by the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute; Cancer Surveillance System of the Fred Hutchinson Cancer Research Center, which is funded by Contract No. N01-CN-67009 and N01-PC-35142 from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute with additional support from the Fred Hutchinson Cancer Research Center and the State of Washington; New Hampshire State Cancer Registry supported in part by cooperative agreement U55/CCU-121912 awarded to the New Hampshire Department of Health and Human Services, Division of Public Health Services, Bureau of Disease Control and Health Statistics, Health Statistics and Data Management Section; Colorado Central Cancer Registry, which is partially supported by the Colorado State General Fund and the federal Centers for Disease Control and Prevention (National Program of Cancer Registries) under Cooperative Agreement U58000848. The ideas and opinions expressed herein are those of the authors and endorsement by the New Hampshire Department of Health and Human Services; the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. ",
year = "2010",
month = apr,
doi = "10.1016/j.jclinepi.2009.06.008",
language = "English (US)",
volume = "63",
pages = "441--451",
journal = "Journal of Clinical Epidemiology",
issn = "0895-4356",
publisher = "Elsevier USA",
number = "4",
}