edward a. sickles, m.d. clinical diagnostic mammography benchmarks
TRANSCRIPT
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Edward A. Sickles, M.D.
Clinical Diagnostic
Mammography Benchmarks
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Importance of Diagnostic Mammography
Screening: recall versus no recall
Diagnostic: biopsy versus no biopsy
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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”
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Importance of Diagnostic Mammography
Benefits: screening ≈ diagnostic
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Importance of Diagnostic Mammography
Benefits: screening ≈ diagnostic
Harms: screening << diagnostic
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Harms of Mammography
Screening
AnxietyInconvenienceResourcesCost
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Harms of Mammography
Screening Diagnostic
AnxietyInconvenienceResourcesCost
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Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenienceResourcesCost
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Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenience More inconvenienceResourcesCost
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Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenience More inconvenienceResources More resourcesCost
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Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenience More inconvenienceResources More resourcesCost More costs
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Harms of Mammography
Screening Diagnostic
Anxiety More anxietyInconvenience More inconvenienceResources More resourcesCost More costs
“Overdiagnosis”
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In the USA, mammography practice is
opportunistic not organized, delivered
locally not regionally or nationally.
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In the USA, mammography practice is
opportunistic not organized, delivered
locally not regionally or nationally.
The same physicians interpret both
screening & diagnostic mammography.
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The same physicians interpret both
screening & diagnostic mammography.
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Dxic: “where the rubber meets the road”
The same physicians interpret both
screening & diagnostic mammography.
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Dxic: “where the rubber meets the road”
Harms: screening << diagnostic
The same physicians interpret both
screening & diagnostic mammography.
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Hence the crucial importance in
monitoring and assessing not only
screening but also diagnostic
mammography performance
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How to Assess Mammo Performance
Observed performance outcomes are
compared to standard performance
parameters that have been designated
as acceptable.
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AJR 2001; 176:729-733
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Diagnostic Examinations
Additional work-up of abnormal screening
Short-interval (6-month) follow-up
Evaluation of a breast problem
- Palpable mass
- Other breast problem
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Performance benchmarks derived from
audits of very large numbers of exams
interpreted by a “population-based
sample” of U.S. radiologists
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Radiology 2005; 235:775-790
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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
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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
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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
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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
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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
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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
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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
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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
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5th Edition
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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
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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
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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