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Senior Citizen Health & Medicine
Mammography Recall of 9.8 Percent with Cancer Rate
of 4.8 Percent Sets Benchmarks for Radiologists
Audit exams of 1.1 million older U.S. women funded by
National Cancer Institute
 September 26, 2006 – A study of 1.1 million older
women who had a mammography exam between 1996 and 2002 has found 9.8
percent of the patients were recalled and ultimately 4.8% were found to
have breast cancer. This audit funded by the National Cancer Institute
says screening results surpass U.S. recommendations and establishes a
benchmark for radiologists. It also provides information helpful to
older women in better understanding results from their breast exams.
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Approximately 188 mammography facilities nationwide
contributed to the study that is reported in the October issue of
Radiology.
After additional imaging work-up on the 9.8%
recalled, cancer was ultimately diagnosed in 4.8 of 1,000 women.
When a radiologist identified significantly
abnormal findings and advised that biopsy be performed immediately, 34
percent of biopsy results yielded cancer.
The majority of women examined were 40 to 70 years
old.
Of all reported cancers,
● 21.6 percent proved to be ductal carcinoma in
situ (an early form of carcinoma defined by the absence of invasion of
surrounding tissues, but if left untreated may transform into a more
malignant form of cancer), and
● 78.4 percent were invasive cancers.
Of invasive cancers,
● 37.2 percent were small tumors measuring 10
millimeters or less in diameter,
● 41.6 percent were mid-sized tumors measuring 11 to 20 millimeters,
and
● 21.2 percent were large invasive tumors measuring 2 centimeters and
larger.
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"With a cancer detection rate of 4.8 per 1,000
women, our results show that most radiologists who are reading
mammograms are performing well," said Robert D. Rosenberg, M.D., lead
researcher and professor of radiology at the University of New Mexico in
Albuquerque. "Mammography, combined with better breast cancer
treatments, appears to be helping to decrease the number of deaths from
breast cancer."
Up until now, there has been no national
measurement with which radiologists could compare their individual
cancer detection rates.
"There have been no data available for
mammographers in the United States to give context to anyone's
individual performance results. All prior guidelines were best guesses
from a panel of experienced radiologists," Dr. Rosenberg explained.
In the study, data were collected from six
NCI-funded research sites, for a total of nearly 2.6 million screening
exams assessed by 807 radiologists. Each radiologist's assessment, along
with every woman's outcome within 12 months of the initial screening
exam, were tallied. The radiologists included in the analysis came from
urban, rural, large and small practices of different organizational
structures, across broad geographic areas.
Approximately 10 percent of mammograms yielded
abnormal findings, for a recall rate of 9.8 percent.
"We found that radiologists are much more likely to
err on the side of caution, for a higher recall rate," said co-author
Bonnie Yankaskas, Ph.D., professor of radiology at the University of
North Carolina at Chapel Hill.
The authors expressed hope that their findings will
allow radiologists to evaluate and improve the accuracy of their
individual cancer detection rates when reading mammograms.
"Recalls and additional biopsies do add to the cost
and anxiety of mammography," said Dr. Rosenberg. "However, we are
continually working to improve the test from both ends--finding cancers
while minimizing unnecessary work-ups."
Notes:
The data collected for this study were gathered
by the Breast Cancer Surveillance Consortium, an initiative funded by
the NCI.
Radiology is a monthly scientific journal devoted
to clinical radiology and allied sciences. The journal is edited by
Anthony V. Proto, M.D., School of Medicine, Virginia Commonwealth
University, Richmond, Va. Radiology is owned and published by the
Radiological Society of North America, Inc. (RSNA.org/radiologyjnl)
The Radiological Society of North America (RSNA)
is an association of more than 38,000 radiologists, radiation
oncologists, medical physicists and related scientists committed to
promoting excellence in radiology through education and by fostering
research, with the ultimate goal of improving patient care. The Society
is based in Oak Brook, Ill. (RSNA.org)
"Performance Benchmarks for Screening
Mammography." Collaborating with Drs. Rosenberg and Yankaskas on this
paper were Linn A. Abraham, M.S., Edward A. Sickles, M.D., Constance D.
Lehman, M.D., Ph.D., Berta M. Geller, Ed.D., Patricia A. Carney, Ph.D.,
Karla Kerlikowske, M.D., Diana S. M. Buist, Ph.D., Donald L. Weaver,
M.D., William E. Barlow, Ph.D., and Rachel Ballard-Barbash, M.D., M.P.H.
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