Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Impact of Surveillance Mammography Intervals Less Than One Year on Performance Measures in Women With a Personal History of Breast Cancer

  • Janie M. Lee (Department of Radiology, University of Washington School of Medicine) ;
  • Laura E. Ichikawa (Kaiser Permanente Washington Health Research Institute) ;
  • Karen J. Wernli (Kaiser Permanente Washington Health Research Institute) ;
  • Erin J. A. Bowles (Kaiser Permanente Washington Health Research Institute) ;
  • Jennifer M. Specht (Fred Hutchinson Cancer Center) ;
  • Karla Kerlikowske (Department of Medicine, University of California San Francisco) ;
  • Diana L. Miglioretti (Kaiser Permanente Washington Health Research Institute) ;
  • Kathryn P. Lowry (Department of Radiology, University of Washington School of Medicine) ;
  • Anna N. A. Tosteson (The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth) ;
  • Natasha K. Stout (Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School) ;
  • Nehmat Houssami (The Daffodil Centre, University of Sydney and Cancer Council New South Wales) ;
  • Tracy Onega (The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth) ;
  • Diana S. M. Buist (Kaiser Permanente Washington Health Research Institute)
  • Received : 2022.12.29
  • Accepted : 2023.05.18
  • Published : 2023.08.01
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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.

Keywords

Acknowledgement

We recognize the support of Suzanne Kolb, MPH, in the analytic and manuscript drafting processes. The collection of cancer and vital status data used in this study was supported in part by several state public health departments and cancer registries throughout the United States. We thank the participating women, mammography facilities, and radiologists for the data they provided for this study. You can learn more about the Breast Cancer Surveillance Consortium (BCSC) at https://www.bcsc-research.org/.

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