Predicting invasive breast cancer versus DCIS in different age groups.

BackgroundIncreasing focus on potentially unnecessary diagnosis and treatment of certain breast cancers prompted our investigation of whether clinical and mammographic features predictive of invasive breast cancer versus ductal carcinoma in situ (DCIS) differ by age.MethodsWe analyzed 1,475 malignant breast biopsies, 1,063 invasive and 412 DCIS, from 35,871 prospectively collected consecutive diagnostic mammograms interpreted at University of California, San Francisco between 1/6/1997 and 6/29/2007. We constructed three logistic regression models to predict the probability of invasive cancer versus DCIS for the following groups: women ≥ 65 (older group), women 50-64 (middle age group), and women < 50 (younger group). We identified significant predictors and measured the performance in all models using area under the receiver operating characteristic curve (AUC).ResultsThe models for older and the middle age groups performed significantly better than the model for younger group (AUC = 0.848 vs, 0.778; p = 0.049 and AUC = 0.851 vs, 0.778; p = 0.022, respectively). Palpability and principal mammographic finding were significant predictors in distinguishing invasive from DCIS in all age groups. Family history of breast cancer, mass shape and mass margins were significant positive predictors of invasive cancer in the older group whereas calcification distribution was a negative predictor of invasive cancer (i.e. predicted DCIS). In the middle age group--mass margins, and in the younger group--mass size were positive predictors of invasive cancer.ConclusionsClinical and mammographic finding features predict invasive breast cancer versus DCIS better in older women than younger women. Specific predictive variables differ based on age

Reactions to uncertainty and the accuracy of diagnostic mammography.

BackgroundReactions to uncertainty in clinical medicine can affect decision making.ObjectiveTo assess the extent to which radiologists' reactions to uncertainty influence diagnostic mammography interpretation.DesignCross-sectional responses to a mailed survey assessed reactions to uncertainty using a well-validated instrument. Responses were linked to radiologists' diagnostic mammography interpretive performance obtained from three regional mammography registries.ParticipantsOne hundred thirty-two radiologists from New Hampshire, Colorado, and Washington.MeasurementMean scores and either standard errors or confidence intervals were used to assess physicians' reactions to uncertainty. Multivariable logistic regression models were fit via generalized estimating equations to assess the impact of uncertainty on diagnostic mammography interpretive performance while adjusting for potential confounders.ResultsWhen examining radiologists' interpretation of additional diagnostic mammograms (those after screening mammograms that detected abnormalities), a 5-point increase in the reactions to uncertainty score was associated with a 17% higher odds of having a positive mammogram given cancer was diagnosed during follow-up (sensitivity), a 6% lower odds of a negative mammogram given no cancer (specificity), a 4% lower odds (not significant) of a cancer diagnosis given a positive mammogram (positive predictive value [PPV]), and a 5% higher odds of having a positive mammogram (abnormal interpretation).ConclusionMammograms interpreted by radiologists who have more discomfort with uncertainty have higher likelihood of being recalled

Accuracy of Short-Interval Follow-Up Mammograms by Patient and Radiologist Characteristics

The purpose of our study was to examine the accuracy of short-interval follow-up mammograms and evaluate patient and radiologist characteristics associated with accuracy

Impact of an Educational Intervention Designed to Reduce Unnecessary Recall during Screening Mammography

To describe the impact of a tailored web based educational program designed to reduce excessive screening mammography recall

Diagnosis of second breast cancer events after initial diagnosis of early stage breast cancer

To examine whether there are any characteristics of women or their initial tumors that might be useful for tailoring surveillance recommendations to optimize outcomes. We followed 17,286 women for up to 5 years after an initial diagnosis of ductal carcinoma in situ (DCIS) or early stage (I/II) invasive breast cancer diagnosed between 1996 and 2006. We calculated rates per 1,000 women years of recurrences and second breast primaries relative to demographics, risk factors, and characteristics of initial diagnosis: stage, treatment, mode of initial diagnosis. Nearly 4% had a second breast cancer event (314 recurrences and 344 second breast primaries). Women who used adjuvant hormonal therapy or were ≥80 years had the lowest rates of second events. Factors associated with higher recurrence and second primary rates included: initial DCIS or stage IIB, estrogen/progesterone receptor-negative, younger women (<50 years). Women with a family history or greater breast density had higher second primary rates, and women who received breast conserving surgery without radiation had higher recurrence rates. Roughly one-third of recurrences (37.6%) and second primaries (36.3%) were not screen-detected. Initial mode of diagnosis was a predictor of second events after adjusting for age, stage, primary treatment, and breast density. A recent negative mammogram should not falsely reassure physicians or women with new breast symptoms or changes because one-third of second cancers were interval cancers. This study does not provide any evidence in support of changing surveillance intervals for different subgroups

Radiologists' Perceptions of Computer Aided Detection Versus Double Reading for Mammography Interpretation

To examine radiologists’ use and perceptions of computer-aided detection (CAD) and double reading for screening mammography interpretation

Feasibility and Acceptability of Conducting a Randomized Clinical Trial Designed to Improve Interpretation of Screening Mammography

To describe recruitment, enrollment and participation in a study of U.S. radiologists invited to participate in a randomized controlled trial of two continuing medical education interventions designed to improve interpretation of screening mammography

Feasibility and Satisfaction with a Tailored Web-based Audit Intervention for Recalibrating Radiologists’ Thresholds for Conducting Additional Work-up

To examine the feasibility of and satisfaction with a tailored web-based intervention designed to decrease radiologists' recommendation of inappropriate additional work-up following a screening mammogram

Using a Tailored Web-based Intervention to Set Goals to Reduce Unnecessary Recall

To examine whether an intervention strategy consisting of a tailored web-based intervention, which provides individualized audit data with peer comparisons and other data that can affect recall can assist radiologists in setting goals for reducing unnecessary recall

Radiologist Agreement for Mammographic Recall by Case Difficulty and Finding Type

To assess agreement of mammography interpretations by community radiologists with consensus interpretations of an expert radiology panel, to inform approaches that improve mammography performance