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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 10 of 10 Research Studies DisplayedHo TH, Bissell MCS, Lee CI
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
The purpose of this study was to establish a prioritization method for immediate interpretation of screening mammograms and potential diagnostic assessment. A cohort based on the population, comprising screening mammograms conducted from 2012 to 2020 at 126 radiology centers from 7 Breast Cancer Surveillance Consortium registries, was examined. Classification trees were used to identify combinations of clinical history (age, BI-RADS density, time elapsed since the previous mammogram, history of false-positive recall or biopsy outcome), screening technique (digital mammography, digital breast tomosynthesis), and facility features (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 classified as high and ≥16/100 as very high. The efficiency ratio was calculated as the percentage of recalls divided by the percentage of mammograms. The research cohort consisted of 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The study found that the primary predictor of recall was the time interval since the last mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening method. Recall rates were extremely high for baseline mammograms and high for women with ≥5 years since their previous mammogram. The 9.2% of mammograms in subgroups with very high and high recall rates represented 19.2% of recalls, yielding an efficiency ratio of 2.1 compared to a random strategy. Including women under 50 with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Findings incorporating facility-level characteristics were analogous.
AHRQ-funded; HS018366
Citation: Ho TH, Bissell MCS, Lee CI .
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
J Am Coll Radiol 2023 Mar;20(3):299-310. doi: 10.1016/j.jacr.2022.09.030.
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Diagnostic Safety and Quality
Rauscher GH, Murphy AM, Qiu Q
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
The authors examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in mammography in a single large health care organization. 2D analog, 2D digital, and 3D digital mammography screenings among women 40-79 years old with cancer follow-up were examined. They found that the results of their investigation were in contrast to those of a recent study suggesting appropriateness of higher recall rates. They concluded that optimal cancer detection appeared to be in the recall rate range of 7-9% for both 2D digital mammography and 3D tomosynthesis.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Murphy AM, Qiu Q .
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
AJR Am J Roentgenol 2021 Apr;216(4):894-902. doi: 10.2214/ajr.19.22429.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Sprague BL, Miglioretti DL, Lee CI
New mammography screening performance metrics based on the entire screening episode.
Established mammography screening performance metrics use the initial screening mammography assessment because they were developed for radiologist performance auditing, yet these metrics are frequently used to inform health policy and screening decision making. The authors developed new performance metrics based on the final assessment that consider the entire screening episode, including diagnostic workup. They concluded that established screening performance metrics underestimated the interval cancer rate of a mammography screening episode, particularly for women with dense breasts or an elevated breast cancer risk.
AHRQ-funded; HS018366.
Citation: Sprague BL, Miglioretti DL, Lee CI .
New mammography screening performance metrics based on the entire screening episode.
Cancer 2020 Jul 15;126(14):3289-96. doi: 10.1002/cncr.32939..
Keywords: Screening, Diagnostic Safety and Quality, Cancer: Breast Cancer, Cancer, Prevention, Women, Provider Performance, Imaging
Sprague BL, Coley RY, Kerlikowske K
Assessment of radiologist performance in breast cancer screening using digital breast tomosynthesis vs digital mammography.
Many US radiologists have screening mammography recall rates above the expert-recommended threshold of 12%. The influence of digital breast tomosynthesis (DBT) on the distribution of radiologist recall rates is uncertain. The objective of this study was to evaluate radiologists' recall and cancer detection rates before and after beginning interpretation of DBT examinations.
AHRQ-funded; HS018366.
Citation: Sprague BL, Coley RY, Kerlikowske K .
Assessment of radiologist performance in breast cancer screening using digital breast tomosynthesis vs digital mammography.
JAMA Netw Open 2020 Mar 2;3(3):e201759. doi: 10.1001/jamanetworkopen.2020.1759..
Keywords: Cancer: Breast Cancer, Cancer, Diagnostic Safety and Quality, Imaging, Screening, Women, Prevention, Provider Performance
Giess CS, Wang A, Ip IK
Patient, radiologist, and examination characteristics affecting screening mammography recall rates in a large academic practice.
This retrospective study examined patient, radiologist and examination characteristics affecting screening mammography recall rates. This study used 61,198 examinations from an academic center and two outpatient centers from October 1, 2012 to May 31, 2015. Radiologists’ risk aversion, stress from uncertainty, and malpractice concerns and cancer detection rates were derived from the survey. Their annual screening volumes, clinical experience, and concentration in breast imaging was calculated. About 9.3% of screening examinations were recalled. There was no association found with radiologists’ risk aversion, stress from uncertainty, malpractice concerns and cancer detection rates and high recall rates. The most variation was found with radiologists’ annual reading volume and experience.
AHRQ-funded; HS24722.
Citation: Giess CS, Wang A, Ip IK .
Patient, radiologist, and examination characteristics affecting screening mammography recall rates in a large academic practice.
J Am Coll Radiol 2019 Apr;16(4 Pt A):411-18. doi: 10.1016/j.jacr.2018.06.016..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Imaging, Prevention, Screening, Women
Dabbous F, Dolecek TA, Friedewald SM
Performance characteristics of digital vs film screen mammography in community practice.
In this study, the investigators examined performance characteristics of digital vs film screen mammography in community practice by comparing the performance characteristics of 297 629 full field digital (FFDM) and 416 791 screen film mammograms (SFM). In their study, modest gains in performance were achieved with the introduction of FFDM as a replacement for SFM, in a large health care organization.
AHRQ-funded; HS018366.
Citation: Dabbous F, Dolecek TA, Friedewald SM .
Performance characteristics of digital vs film screen mammography in community practice.
Breast J 2018 May;24(3):369-72. doi: 10.1111/tbj.12942..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Comparative Effectiveness, Diagnostic Safety and Quality
Murphy DR, Meyer AND, Vaghani V
Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care.
Because of the unique clinical, logistic, and legal aspects of mammography, this study was conducted to evaluate the effectiveness of a trigger to flag delayed follow-up on mammography. The investigators found that care delays appeared to continue despite federal laws requiring patient notification of mammographic results within 30 days. They suggest that clinical application of mammography-related triggers could help detect these delays.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer AND, Vaghani V .
Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care.
J Am Coll Radiol 2018 Feb;15(2):287-95. doi: 10.1016/j.jacr.2017.10.001..
Keywords: Cancer: Breast Cancer, Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging, Diagnostic Safety and Quality, Prevention, Women
Dabbous FM, Dolecek TA, Berbaum ML
Impact of a false-positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis.
Researchers sought to examine the impact of a false positive (FP) screening mammogram on the subsequent screening mammography behavior. They found that experiencing a FP mammogram increases the risk of late stage at diagnosis compared with prior true negative (TN) mammogram Also, women with a FP mammogram were more likely to delay their subsequent screening compared with women with a TN mammogram.
AHRQ-funded; HS018366.
Citation: Dabbous FM, Dolecek TA, Berbaum ML .
Impact of a false-positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis.
Cancer Epidemiol Biomarkers Prev 2017 Mar;26(3):397-403. doi: 10.1158/1055-9965.epi-16-0524.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Nelson HD, O'Meara ES, Kerlikowske K
Factors associated with rates of false-positive and false-negative results from digital mammography screening: an analysis of registry data.
The researchers sought to determine factors associated with false-positive and false-negative digital mammography results, additional imaging, and biopsies among a general population of women screened for breast cancer. They found that false-positive mammography results and additional imaging are common, particularly for younger women and those with risk factors, whereas biopsies occur less often. Rates of false-negative results are low.
AHRQ-funded; 290201200015I.
Citation: Nelson HD, O'Meara ES, Kerlikowske K .
Factors associated with rates of false-positive and false-negative results from digital mammography screening: an analysis of registry data.
Ann Intern Med 2016 Feb 16;164(4):226-35. doi: 10.7326/m15-0971.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Diagnostic Safety and Quality, Women, Screening, Prevention
Vyas A, Madhavan S, Sambamoorthi U
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
The objective of this study is to determine the association between persistence with mammography screening and stage at breast cancer (BC) diagnosis among elderly women. It found that, as compared to women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed at earlier stages of BC.
AHRQ-funded; HS018622.
Citation: Vyas A, Madhavan S, Sambamoorthi U .
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
Breast Cancer Res Treat 2014 Dec;148(3):645-54. doi: 10.1007/s10549-014-3204-3..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Elderly, Prevention, Screening, Women