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Association between Mammography Timing and Measures of Screening Performance in the United States¹

¹ From the Department of Radiology, University of North Carolina at Chapel Hill, CB 7515, 106 Mason Farm Rd, Chapel Hill, NC 27599-7515 (B.C.Y.). Affiliations for all other authors are listed at the end of this article. Received January 9, 2004; revision requested March 12; revision received April 20; accepted May 24. Supported by cooperative agreements UO1CA63731, UO1CA63736, UO1CA63740, UO1CA69976, UO1CA70013, UO1CA70040, UO1CA86076, and UO1CA86082 from the National Cancer Institute as part of the Breast Cancer Surveillance Consortium of the National Cancer Institute. S.H.T. was the principal investigator on grant CA69976. Address correspondence to B.C.Y. (e-mail: bcy@med.unc.edu).

PURPOSE: To evaluate whether there is an association between the number of months since previous mammography (MSPM) and performance measures (sensitivity, specificity, recall rate, cancer detection rate, and positive predictive value) in women who underwent U.S. community-based screening mammography.

MATERIALS AND METHODS: Data from seven registries (Breast Cancer Surveillance Consortium) and mammographic data and cancer outcome in regard to 1 213 754 screening mammographic examinations performed in 680 641 women who were 40–89 years old for the years 1996–2000 were used in this study. These data are submitted annually in a standard format to a central statistical coordinating center that is subject to institutional review board approval, quality control, and confidentiality standards. Performance measures were calculated for first and subsequent screening mammography. For subsequent mammography, performance measures were calculated according to categories of MSPM (9–15, 16–20, 21–27, and 28 months). Receiver operating characteristic and multivariable logistic regression analyses were conducted to test the association between the number of MSPM and performance measures.

RESULTS: With increasing MSPM in each category from 9–15 to 28 months or more and for first mammographic examinations, respectively, there was increased sensitivity (70.9%, 75.7%, 85.4%, 82.5%, and 88.6%), decreased specificity (93.3%, 92.7%, 91.6%, 91.0%, and 85.9%), increased recall rate (7.0%, 7.6%, 8.8%, 9.4%, and 14.7%), and increased cancer detection rates (3.2, 3.5, 4.5, 4.6, and 6.1 per 1000 mammographic examinations). When the category of 9–15 MSPM was compared with that of 21–27 MSPM, there was a slight increase in positive predictive value from 4.6% to 5.1%. Confidence intervals were narrow and did not overlap. Age affected these associations for all performance measures except sensitivity.

CONCLUSION: Performance measures increased as MSPM increased, except for specificity, which decreased. Time between mammograms is an important factor to consider when audits are reviewed or screening performance measures are compared.

© RSNA, 2005

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