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Organized Breast Screening Programs in Canada: Effect of Radiologist Reading Volumes on Outcomes¹

¹ From Population and Preventive Oncology, British Columbia Cancer Agency, 686 W Broadway, Suite 800, Vancouver, BC, Canada V5Z 1G1 (A.J.C., Y.D., N.P.); Institut National de Santé Publique du Québec, Québec City, Québec, Canada (D.M.); Newfoundland Screening Program, St John's, Newfoundland, Canada (G.P.D.); Screening and Early Detection Section, Health Canada, Ottawa, Ontario, Canada (J.O.); Cancer Care Ontario, Toronto, Ontario, Canada (R.S.); Queen Elizabeth Prince Edward Island Mammography Department, Charlottetown, Prince Edward Island, Canada (N.E.S.); and Diagnostic Imaging, St Clare's Mercy Hospital, St John's, Newfoundland, Canada (N.W.). Received September 30, 2004; revision requested December 14; revision received January 20, 2005; accepted February 21; final version accepted April 20. Address correspondence to A.J.C. (e-mail: acoldman{at}bccancer.bc.ca).

Purpose: To examine retrospectively the relationship between radiologist screening program reading volumes and interpretation results.

Materials and Methods: This research project was reviewed by the University of British Columbia Research Ethics Board. Informed patient consent was not required. Data were requested from Canadian provincial screening programs for the period 1988–2000. Cancer detection rates, abnormal interpretation rates, and positive predictive values (PPVs) were calculated for individual radiologists in those programs. Multivariate Poisson mixed regression models were used to examine the effect of patient age, screening examination sequence (first or subsequent screening examination), province, radiologist reading volume, and interradiologist differences on cancer detection rate, abnormal interpretation rate, and PPV.

Results: The results of the interpretation of 1406678 screening mammograms by 304 radiologists from seven provincial programs were analyzed. Cancer detection rate, abnormal interpretation rate, and PPV all varied according to age of woman screened and screening sequence and across the sample of radiologists. None of the rates varied by province. Neither the cancer detection rate nor the abnormal interpretation rate varied by reading volume, but the average PPV was increased by 34% for volumes over 2000 mammograms versus volumes of 480–699 mammograms per year. There was no evidence that the magnitude of variability around the average, for radiologists reading the same volume of mammograms, varied across different volume groups for any of the outcome measures.

Conclusion: Cancer detection did not vary with reading volume. The average PPV for individual radiologists increased as reading volume rose up to 2000 mammograms per year; it stabilized at higher volumes.

© RSNA, 2006

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