Korean J Radiol.
2023 Aug;24(8):729-738. 10.3348/kjr.2022.1038.
Impact of Surveillance Mammography Intervals Less Than One Year on Performance Measures in Women With a Personal History of Breast Cancer
- Lee JM
1,2 - Ichikawa LE3
- Wernli KJ3,4
- Bowles EJA3
- Specht JM2,5
- Kerlikowske K6,7,8
- Miglioretti DL3,9
- Lowry KP1,2
- Tosteson ANA10,11
- Stout NK12
- Houssami N13
- Onega T10,14
- Buist DSM3,4
- Affiliations
-
- 1Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- 2Fred Hutchinson Cancer Center, Seattle, WA, USA
- 3Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- 4Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, CA, USA
- 5Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- 6Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- 7Department of Veterans Affairs, University of California San Francisco, San Francisco, CA, USA
- 8Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- 9Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
- 10The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- 11Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- 12Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
- 13The Daffodil Centre, University of Sydney and Cancer Council New South Wales, Kings Cross, New South Wales, Australia
- 14Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- KMID: 2544926
- DOI: http://doi.org/10.3348/kjr.2022.1038
Abstract
Objective
When multiple surveillance mammograms are performed within an annual interval, the current guidance for oneyear follow-up to determine breast cancer status results in shared follow-up periods in which a single breast cancer diagnosis can be attributed to multiple preceding examinations, posing a challenge for standardized performance assessment. We assessed the impact of using follow-up periods that eliminate the artifactual inflation of second breast cancer diagnoses.
Materials and Methods
We evaluated surveillance mammograms from 2007–2016 in women with treated breast cancer linked with tumor registry and pathology outcomes. Second breast cancers included ductal carcinoma in situ or invasive breast cancer diagnosed during one-year follow-up. The cancer detection rate, interval cancer rate, sensitivity, and specificity were compared using different follow-up periods: standard one-year follow-up per the American College of Radiology versus follow-up that was shortened at the next surveillance mammogram if less than one year (truncated follow-up). Performance measures were calculated overall and by indication (screening, evaluation for breast problem, and short interval follow-up).
Results
Of 117971 surveillance mammograms, 20% (n = 23533) were followed by another surveillance mammogram within one year. Standard follow-up identified 1597 mammograms that were associated with second breast cancers. With truncated follow-up, the breast cancer status of 179 mammograms (11.2%) was revised, resulting in 1418 mammograms associated with unique second breast cancers. The interval cancer rate decreased with truncated versus standard follow-up (3.6 versus 4.9 per 1000 mammograms, respectively), with a difference (95% confidence interval [CI]) of -1.3 (-1.6, -1.1). The overall sensitivity increased to 70.4% from 63.7%, for the truncated versus standard follow-up, with a difference (95% CI) of 6.6% (5.6%, 7.7%). The specificity remained stable at 98.1%.
Conclusion
Truncated follow-up, if less than one year to the next surveillance mammogram, enabled second breast cancers to be associated with a single preceding mammogram and resulted in more accurate estimates of diagnostic performance for national benchmarks.
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