Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation on the Basis of Risk for Recall
Year: 2022
Type: article
Study design: Observational Study
Abstract: PURPOSE: The aim of this study was to develop a prioritization strategy for scheduling immediate screening mammographic interpretation and possible diagnostic evaluation. METHODS: A population-based cohort with screening mammograms performed from 2012 to 2020 at 126 radiology facilities from 7 Breast Cancer Surveillance Consortium registries was identified. Classification trees identified combinations of clinical history (age, BI-RADS® density, time since prior mammogram, history of false-positive recall or biopsy result), screening modality (digital mammography, digital breast tomosynthesis), and facility characteristics (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 considered high and ≥16/100 very high. An efficiency ratio was estimated as the percentage of recalls divided by the percentage of mammograms. RESULTS: The study cohort included 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The most important predictor of recall was time since prior mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening modality. Recall rates were very high for baseline mammograms (21.3/100; 95% confidence interval, 19.7-23.0) and high for women with ≥5 years since prior mammogram (15.1/100; 95% confidence interval, 14.3-16.1). The 9.2% of mammograms in subgroups with very high and high recall rates accounted for 19.2% of recalls, an efficiency ratio of 2.1 compared with a random approach. Adding women <50 years of age with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Results including facility-level characteristics were similar. CONCLUSIONS: Prioritizing women with baseline mammograms or ≥5 years since prior mammogram for immediate interpretation and possible diagnostic evaluation could considerably reduce the number of women needing to return for diagnostic imaging at another visit.
Institutions: University Medical Center HCMC, Tam Anh General Hospital, Ho Chi Minh City, University of California, Davis, University of Washington, Fred Hutch Cancer Center, University of Vermont, Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Cancer Center, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Bernard J. Tyson School of Medicine, University of North Carolina at Chapel Hill, UNC Lineberger Comprehensive Cancer Center, San Francisco VA Medical Center, University of California, San Francisco, San Francisco VA Health Care System, UC Davis Comprehensive Cancer Center
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,530
Funders: Patient-Centered Outcomes Research Institute, Comprehensive Cancer Center, City of Hope, American College of Radiology, University of Vermont, Lake Champlain Cancer Research Organization, Japanese Association of Cardiac Rehabilitation, University of Oxford, National Institutes of Health, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, GE Healthcare, University of California, Davis, National Cancer Institute
OpenAlex ID: W4306956227