Breast imaging in a military setting: a comparison with civilian breast imaging

A retrospective study was performed to evaluate breast imaging in the Wilford Hall Medical Center, the largest medical facility in the U.S. Air Force, from the time period of October 1997 to October 2000, in comparison with its civilian counterparts. The results demonstrate that although Wilford Hall Medical Center breast imaging is faced with unique difficulties in having a relatively mobile patient and physician population, military breast imaging corresponds with civilian breast imaging in the following aspects: screening the eligible population according to age and risk factors, cancer and precancerous abnormality detection rate, and biopsy techniques, including stereotactic-guided vacuum-assisted, automated gun biopsy, ultrasound-guided biopsy, and needle localization-assisted excision biopsy. Positive predictive value based on biopsy recommendations are lower than in civilian practice, likely because military radiologists are keenly aware of the mobile status of their population and are more aggressive in recommending biopsy for a definitive diagnosis rather than mammographic follow up. In our practice, cancer diagnosed at stage 0 or 1 is 85%, 4.3% of patients have positive lymph nodes, the overall cancer detection rate per 1,000 population is 3.97, the recall rate is 8.8%, sensitivity is 100%, and specificity is 98.1%. All of these aspects are comparable with those of civilian practice.