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Improving the Concordance of Mammography Assessment and Management Recommendations¹

¹ From the Office of Health Promotion Research, University of Vermont, 1 S Prospect St, Rm 4427D, Burlington, VT 05401-3444 (B.M.G.); Center for Health Studies, Group Health Cooperative, Seattle, Wash (L.E.I., D.S.M.B., W.B.); University of California, San Francisco, San Francisco, Calif (E.A.S., K.K.); Dartmouth Medical School, Norris Cotton Cancer Center, Lebanon, NH (P.A.C.); University of North Carolina at Chapel Hill, Chapel Hill, NC (B.C.Y.); Cooper Institute, Denver, Colo (M.D.); Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (K.R.Y.); and University of New Mexico, Albuquerque, NM (R.D.R.). Received August 16, 2005; revision requested October 21; revision received November 28; final version accepted January 2, 2006. Data collection supported by a National Cancer Institute–funded Breast Cancer Surveillance Consortium cooperative agreement (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040). Address correspondence to B.M.G. (e-mail: berta.geller{at}uvm.edu).

Purpose: To retrospectively compare the concordance of initial and final assessment categories for mammograms with management recommendations made before and after the final rules of the Mammography Quality Standards Act (MQSA) were in effect for screening and diagnostic mammography.

Materials and Methods: The study included mammograms from 1996 to 2001 from the seven mammography registries of the Breast Cancer Surveillance Consortium (BCSC). The authors defined the pre-MQSA period as January 1, 1996–April 27, 1999, and the post-MQSA period as April 28, 1999–December 31, 2001 (2470151 screening and 194199 diagnostic mammograms). Assessment was cross-classified according to management recommendation. Changes in concordance between assessment and recommendation were evaluated by year and by period (before and after MQSA) for computer-linked data and for all data by using Pearson ² test to evaluate differences. Mantel-Haenszel ² test was used to measure change in concordance over time. Each registry and the BCSC Statistical Coordinating Center had a Federal Certificate of Confidentiality and approval from each institution's review board for protection of human subjects to collect and send data to coordinating center and conduct research with these data. Active consent was required at only one site in this HIPAA-compliant study.

Results: Concordance increased significantly in the post-MQSA period for Breast Imaging Reporting and Data System categories 3–5 assessments at both screening and diagnostic mammography. The most substantial improvements were in the use of the management recommendation for "additional imaging," which decreased from 41% in 1996 to 15% in 2001 for screening mammograms with an initial assessment of category 4 (P < .001). Recommendation for short-interval follow-up in women with screening mammograms with a category 3 final assessment increased from 51% in 1996 to 76% in 2001 (P < .001). Concordance for diagnostic mammograms assigned category 0 improved from 65% in the pre-MQSA period to 81% in the post-MQSA period (P < .001).

Conclusion: This analysis demonstrates that over a relatively short period of time, major improvement in radiology reporting has occurred.

© RSNA, 2006

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