edward a. sickles, m.d. clinical diagnostic mammography benchmarks
TRANSCRIPT
Edward A. Sickles, M.D.
Clinical Diagnostic
Mammography Benchmarks
Importance of Diagnostic Mammography
Screening: recall versus no recall
Diagnostic: biopsy versus no biopsy
Importance of Diagnostic Mammography
Screening: recall versus no recall
Diagnostic: biopsy versus no biopsy
Screening: who gets diagnostic
Dxic: “where the rubber meets the road”
Importance of Diagnostic Mammography
Benefits: screening ≈ diagnostic
Importance of Diagnostic Mammography
Benefits: screening ≈ diagnostic
Harms: screening << diagnostic
Harms of Mammography
Screening
AnxietyInconvenienceResourcesCost
Harms of Mammography
Screening Diagnostic
AnxietyInconvenienceResourcesCost
Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenienceResourcesCost
Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenience More inconvenienceResourcesCost
Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenience More inconvenienceResources More resourcesCost
Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenience More inconvenienceResources More resourcesCost More costs
Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenience More inconvenienceResources More resourcesCost More costs
“Overdiagnosis”
In the USA, mammography practice is
opportunistic not organized, delivered
locally not regionally or nationally.
In the USA, mammography practice is
opportunistic not organized, delivered
locally not regionally or nationally.
The same physicians interpret both
screening & diagnostic mammography.
The same physicians interpret both
screening & diagnostic mammography.
Dxic: “where the rubber meets the road”
The same physicians interpret both
screening & diagnostic mammography.
Dxic: “where the rubber meets the road”
Harms: screening << diagnostic
The same physicians interpret both
screening & diagnostic mammography.
Hence the crucial importance in
monitoring and assessing not only
screening but also diagnostic
mammography performance
How to Assess Mammo Performance
Observed performance outcomes are
compared to standard performance
parameters that have been designated
as acceptable.
AJR 2001; 176:729-733
Diagnostic Examinations
Additional work-up of abnormal screening
Short-interval (6-month) follow-up
Evaluation of a breast problem
- Palpable mass
- Other breast problem
Performance benchmarks derived from
audits of very large numbers of exams
interpreted by a “population-based
sample” of U.S. radiologists
Radiology 2005; 235:775-790
Abnormal Interpretation Rate: 1996-2002
112,917 Exams 97,123 Exams
99,737 Exams 72,307 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
PPV2 (Biopsy Recommended): 1996-2002
112,917 Exams 97,123 Exams
99,737 Exams 72,307 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
PPV3 (Biopsy Performed): 1996-2002
112,917 Exams 97,123 Exams
99,737 Exams 72,307 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
Cancer Diagnosis Rate: 1996-2002
105,378 Exams 88,750 Exams
90,318 Exams 62,793 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
Mean Invasive Cancer Size: 1996-2002
105,378 Exams 88,750 Exams
90,318 Exams 62,793 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
Percent Minimal Cancer: 1996-2002
105,378 Exams 88,750 Exams
90,318 Exams 62,793 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
Percent Node Negative: 1996-2002
88,750 Exams
90,318 Exams 62,793 Exams
88,750 Exams105,378 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
Percent Stage 0 or I: 1996-2002
105,378 Exams 88,750 Exams
90,318 Exams 62,793 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
5th Edition
BI-RADS 5th Edition: BCSC Contributions
Separate screening / diagnostic audits
6 of 15 “see more” reference citations
Elimination of percent density guidance
Revised definition for cat. 3 at screening
Angoff-consensus screening cut points
Updated plots of all measured outcomes
Cancer Diagnosis Rate: 1996-2002
105,378 Exams 88,750 Exams
90,318 Exams 62,793 Exams
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic
176,943 Exams 137,639 Exams
160,189 Exams 92,764 Exams
Cancer Diagnosis Rate: 1996-2005