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Diagnostic imaging and biopsy pathways following abnormal screen-film and digital screening mammography

  • Epidemiology
  • Published:
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Abstract

The transition from screen-film to digital mammography may have altered diagnostic evaluation of women following a positive screening examination. This study compared the use and timeliness of diagnostic imaging and biopsy for women screened with screen-film or digital mammography. Data were obtained from 35,321 positive screening mammograms on 32,087 women aged 40–89 years, from 22 breast cancer surveillance consortium facilities in 2005–2008. Diagnostic pathways were classified by their inclusion of diagnostic mammography, ultrasound, magnetic resonance imaging, and biopsy. We compared time to resolution and frequency of diagnostic pathways by patient characteristics, screening exam modality, and radiology facility. Between-facility differences were evaluated by computing the proportion of mammograms receiving follow-up with a particular pathway for each facility and examining variation in these proportions across facilities. Multinomial logistic regression adjusting for age, calendar year, and facility compared odds of follow-up with each pathway. The median time to resolution of a positive screening mammogram was 10 days. Compared to screen-film mammograms, digital mammograms were more frequently followed by only a single diagnostic mammogram (46 vs. 36 %). Pathways following digital screening mammography were also less likely to include biopsy (16 vs. 20 %). However, in adjusted analyses, most differences were not statistically significant (p = 0.857 for mammography only; p = 0.03 for biopsy). Substantial variability in diagnostic pathway frequency was seen across facilities. For instance, the frequency of evaluation with diagnostic mammography alone ranged from 23 to 55 % across facilities. Differences in evaluation of positive digital and screen-film screening mammograms were minor, and appeared to be largely attributable to substantial variation between radiology facilities. To guide health systems in their efforts to eliminate practices that do not contribute to effective care, we need further research to identify the causes of this variation and the best evidence-based approach for follow-up.

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Acknowledgments

This study was supported by the National Cancer Institute-funded Breast Cancer Surveillance Consortium (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040, HHSN261201100031C). Work by Dr. Hubbard and Ms. Zhu was also supported in part by a grant from GE Healthcare. The collection of cancer data used in this study was supported in part by several state public health departments and cancer registries throughout the U.S. For a full description of these sources, please see: http://www.breastscreening.cancer.gov/work/acknowledgement.html. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. A list of the BCSC investigators and procedures for requesting BCSC data for research purposes are provided at: http://breastscreening.cancer.gov/.

Conflict of interest

  Mr. Horblyuk, Dr. Lee, and Dr. Sweet are employees of GE Healthcare. The authors declare they have no conflicts of interest.

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Authors and Affiliations

  1. Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA

    Rebecca A. Hubbard, Weiwei Zhu & Diana S. M. Buist

  2. Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA

    Rebecca A. Hubbard

  3. GE Healthcare, Waukesha, WI, USA

    Ruslan Horblyuk & David Lee

  4. Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA

    Leah Karliner

  5. Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, VT, USA

    Brian L. Sprague

  6. Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Louise Henderson

  7. Department of Community and Family Medicine, Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, NH, USA

    Tracy Onega

  8. Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA

    Diana S. M. Buist

  9. Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA

    Diana S. M. Buist

  10. GE Healthcare, Chalfont St. Giles, Buckinghamshire, UK

    Alison Sweet

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  1. Rebecca A. Hubbard
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  2. Weiwei Zhu
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  3. Ruslan Horblyuk
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  4. Leah Karliner
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  5. Brian L. Sprague
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  6. Louise Henderson
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  7. David Lee
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  8. Tracy Onega
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  9. Diana S. M. Buist
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  10. Alison Sweet
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Corresponding author

Correspondence to Rebecca A. Hubbard.

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Hubbard, R.A., Zhu, W., Horblyuk, R. et al. Diagnostic imaging and biopsy pathways following abnormal screen-film and digital screening mammography. Breast Cancer Res Treat 138, 879–887 (2013). https://doi.org/10.1007/s10549-013-2466-5

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  • DOI: https://doi.org/10.1007/s10549-013-2466-5

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