Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment

Abstract

Background

The accuracy of mammography reading varies among radiologists. We conducted a population-based assessment on radiologist variation in false- positive rates of screening mammography and its associated radiologist characteristics.

Methods

About 27,394 screening mammograms interpreted by 1067 radiologists were identified from a 5% non-cancer sample of Medicare claims during 1998–1999. The data were linked to the American Medical Association Masterfile to obtain radiologist characteristics. Multilevel logistic regression models were used to examine the radiologist variation in false-positive rates of screening mammography and the associated radiologist characteristics.

Results

Radiologists varied substantially in the false-positive rates of screening mammography (ranging from 1.5 to 24.1%, adjusting for patient characteristics). A longer time period since graduation is associated with lower false-positive rates (odds ratio [OR] for every 10 years increase: 0.87, 95% Confidence Interval [CI], 0.81–0.94) and female radiologists had higher false-positive rates than male radiologists (OR = 1.25, 95% CI, 1.05–1.49), adjusting for patient and other radiologist characteristics. The unmeasured factors contributed to about 90% of the between-radiologist variance.

Conclusions

Radiologists varied greatly in accuracy of mammography reading. Female and more recently trained radiologists had higher false-positive rates. The variation among radiologists was largely due to unmeasured factors, especially unmeasured radiologist factors. If our results are confirmed in further studies, they suggest that system-level interventions would be required to reduce variation in mammography interpretation.

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Acknowledgements

This study is supported by grants from National Cancer Institute, National Institutes of Health (R01CA072076 and P50CA105631) and the Agency for Healthcare Research and Quality (R24HS011618). The study used the linked SEER-Medicare Database. The interpretations and reporting of the data are the sole responsibility of the authors. The authors acknowledge the efforts of: the Applied Research Branch, Division of Cancer Prevention and Population Science, NCI; the Office of Information Services, and the Office of Strategic Planning, HCFA; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

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Correspondence to Alai Tan.

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Tan, A., Freeman, D.H., Goodwin, J.S. et al. Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment. Breast Cancer Res Treat 100, 309–318 (2006). https://doi.org/10.1007/s10549-006-9252-6

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Keywords

  • False-positive
  • Mammography
  • Medicare claims
  • Older women