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Related Experiment Videos

International variation in screening mammography interpretations in community-based programs.

Joann G Elmore1, Connie Y Nakano, Thomas D Koepsell

  • 1Department of Medicine, University of Washington, Seattle, USA. jelmore@u.washington.edu

Journal of the National Cancer Institute
|September 18, 2003
PubMed
Summary

North American mammography screening shows higher abnormal interpretation rates without clear cancer detection benefits. This leads to increased ductal carcinoma in situ (DCIS) diagnoses but not necessarily earlier detection of minimal disease.

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Area of Science:

  • Radiology and Medical Imaging
  • Public Health
  • Oncology

Background:

  • Mammography interpretation variability has significant clinical and economic consequences.
  • International differences in screening program outcomes are not well understood.
  • This study addresses the need to evaluate global variations in mammography interpretation.

Purpose of the Study:

  • To assess international variability in mammography interpretation and clinical outcomes.
  • To compare North American screening programs with those from other countries.
  • To identify factors influencing interpretation differences and their impact on cancer detection.

Main Methods:

  • A meta-regression analysis of 32 publications from MEDLINE on community-based screening programs.

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  • Data abstraction included population demographics, examination techniques, and outcomes like abnormal interpretation rates, positive predictive values (PPV(A), PPV(B)), and rates of ductal carcinoma in situ (DCIS) and minimal disease.
  • Statistical comparison between North American and international screening programs.

    • Main Results:

    • Significant international variation observed in abnormal mammogram rates (1.2%-15.0%), PPV(A) (3.4%-48.7%), PPV(B) (5.0%-85.2%), DCIS diagnosis (4.3%-68.1%), and minimal disease diagnosis (14.0%-80.6%).
    • North American programs showed 2-4 percentage points higher abnormal mammogram rates compared to international programs, after adjusting for covariates.
    • Higher abnormal interpretation rates were negatively associated with PPV(A) and PPV(B) but positively associated with DCIS frequency.

    Conclusions:

    • North American mammography screening programs interpret a higher percentage of mammograms as abnormal compared to international programs.
    • This increased interpretation rate did not yield a clear benefit in overall cancer detection per 1000 screens.
    • An increase in ductal carcinoma in situ (DCIS) detection was noted in North American programs, but the clinical significance requires further evaluation.