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False + mammogramsFrom: Joanne Bulley, MD (islesannie@yahoo.com)Thu Sep 25 21:10:14 2003
Reuters Health Information 2003. © 2003 Reuters Ltd. Mammograms More Likely to Be False Positive in North America NEW YORK (Reuters Health) Sept 16 - Radiologists in North America are more prone to labeling screening mammograms as abnormal than their counterparts in other countries, investigators in the U.S. report. According to a report in the Journal of the National Cancer Institute for September 17, false-positive results are of concern because they increase patient anxiety, costs per case, and the number of diagnostic procedures performed. The tradeoff is likely to be a reduced incidence of missed or delayed diagnoses, which could ultimately save costs. Dr. Joann G. Elmore at the University of Washington, Seattle, and colleagues identified 32 reports about screening mammography results in community-based practices in or after 1985. Eight reports were from North America. One was from Hong Kong, three were from Australia, and the remainder were from Europe. The proportion of mammogram readings that resulted in further diagnostic evaluation ranged from 5.5% to 15.0% in the North American programs and 1.2% to 12.6% in those of other countries. Weighted mean averages were 8.4% and 5.6%, respectively (p = 0.018). The positive predictive value of an abnormal reading ranged from 4.4% to 12.2% in North America, and from 3.4% to 48.7% in other countries. The differences remained significant after adjusting for the percentage of women under age 50, reported calendar year, number of readers, and number of radiographic views per breast. Program location was the most significant predictor of abnormal findings. The percentage of mammograms deemed abnormal was inversely associated with positive predictive value, both for screening and for biopsy results. The proportion of abnormal mammograms was associated with proportion of ductal carcinoma in situ (DCIS) cases among women diagnosed with cancer and the number of DCIS cases diagnosed per 1000 screens. The authors offer several possible explanations for the observed heterogeneity. These include characteristics of the population screened, such as age and proportion of those undergoing first screening; features of the health care system, such as malpractice concerns and financial incentives; and physician characteristics. "A better understanding of the sources of variability in mammography may lead to more effective screening programs that have a lower percentage of mammograms judged as abnormal without substantially lowering the cancer detection rate," Dr. Elmore's group concludes. J Natl Cancer Inst 2003;95:1384-1393.
-- Joanne Bulley, MD Keene, NH, USA
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