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Breast Imaging |
1 From the Depts of Medicine and Epidemiology and Biostatistics (K.K.) and Radiology (R.S.B., E.A.S.), Univ of California, San Francisco; General Internal Medicine Section, San Francisco Veterans Affairs Medical Ctr, 111A1, 4150 Clement St, San Francisco, CA 94121 (K.K.); Ctr for Health Studies, Group Health Cooperative, Seattle, Wash (L.A., C.L., W.E.B.); Dept of Radiology, Univ of Washington Medical Ctr, Seattle Cancer Care Alliance, Seattle, Wash (C.L.); Dept of Radiology, Univ of North Carolina, Chapel Hill (B.C.Y.); Applied Research Program, DCCPS, National Cancer Institute, Bethesda, Md (R.B.B.); Dept of Biostatistics, Univ of Washington, Seattle (W.E.B.); Cancer Research and Biostatistics, Seattle, Wash (W.E.B.); Ctr for Research Methods and Biometry, The Cooper Institute, Denver, Colo (J.H.V.); Health Promotion Research, Univ of Vermont, College of Medicine, Burlington (B.M.G.); and Norris Cotton Cancer Ctr/Dartmouth-Hitchcock Medical Ctr/Dept of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH (P.A.C.). Received Dec 17, 2003; revision requested Feb 23, 2004; final revision received May 11; accepted Jun 18. Supported by a NCI-funded Breast Cancer Surveillance Consortium cooperative agreement (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA63731, U01CA70040). Address correspondence to K.K. (e-mail: kerliko@itsa.ucsf.edu).
PURPOSE: To compare cancer yield for screening examinations with recommendation for short-interval follow-up after diagnostic imaging work-up versus after screening mammography only.
MATERIALS AND METHODS: From January 1996 to December 1999, Breast Imaging Reporting and Data System assessments and recommendations were collected prospectively for 1171792 screening examinations in 758 015 women aged 40–89 years at seven mammography registries in Breast Cancer Surveillance Consortium. Registries obtained waiver of signed consent or collected signed consent in accordance with institutional review boards at each location. Diagnosis of invasive cancer or ductal carcinoma in situ within 24 months of screening examination and tumor stage and size for invasive cancer were determined through linkage to pathology database or tumor registry. 
2 test was used to determine significant differences between groups.
RESULTS: Overall, 5.2% of first and 1.7% of subsequent screens included recommendation for short-interval follow-up, which was similar to likelihood of recommendation for diagnostic evaluation (first screens, 4.6%; subsequent, 2.6%). Most recommendations for short-interval follow-up were based on screening mammography alone (86.2% of first screens, 77.5% of subsequent). Yield of cancer for screening examinations with probably benign finding (PBF) and recommendation for short-interval follow-up based on screening mammography alone tended to be lower than in those with PBF and recommendation for short-interval follow-up after additional work-up (first screens: 0.54% vs 0.96%, P = .10; subsequent: 1.50% vs 1.73%, P = .26). Proportion of stage II and higher disease tended to be higher for examinations with PBF and recommendation for short-interval follow-up based on screening mammography alone compared with those recommended for short-interval follow-up after additional work-up (first screens: 34.7% vs 24.4%, P = .43; subsequent: 27.5% vs 19.2%, P = .13).
CONCLUSION: Many first screening examinations include recommendation for short-interval follow-up based on screening mammography alone. Cancer yield for these examinations is low and is lower than that with diagnostic work-up prior to short-interval follow-up recommendation. Absence of diagnostic work-up prior to short-interval follow-up recommendation may result in periodic surveillance of a high proportion of benign lesions.
© RSNA, 2005
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