Early detection decreases breast cancer mortality. The ACR recommends annual mammographic screening beginning at age 40 for women of average risk. Higher-risk women should start mammographic screening earlier and may benefit from supplemental screening modalities. For women with genetics-based increased risk (and their untested first-degree relatives), with a calculated lifetime risk of 20% or more or a history of chest or mantle radiation therapy at a young age, supplemental screening with contrast-enhanced breast MRI is recommended. Breast MRI is also recommended for women with personal histories of breast cancer and dense tissue, or those diagnosed by age 50. Others with histories of breast cancer and those with atypia at biopsy should consider additional surveillance with MRI, especially if other risk factors are present. Ultrasound can be considered for those who qualify for but cannot undergo MRI. All women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be identified and can benefit from supplemental screening.
The average lifetime risk of breast cancer for a woman in the United States has been estimated at 12.3% (ie, 1 in 8 women). 1 For 2018, the American Cancer Society (ACS) estimates that 63,960 cases of female carcinoma in situ of the breast and 268,670 cases of invasive breast cancer (266,120 women and 2,550 men) will be diagnosed in the United States. 2 About 41,400 deaths are estimated for 2018. 3 The good news is that death rates have been falling on average NCCN
Purpose:To examine whether U.S. radiologists' interpretive volume affects their screening mammography performance.
Materials and Methods:Annual interpretive volume measures (total, screening, diagnostic, and screening focus [ratio of screening to diagnostic mammograms]) were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783 965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year. BCSC registries and the Statistical Coordinating Center received institutional review board approval for active or passive consenting processes and a Federal Certifi cate of Confi dentiality and other protections for participating women, physicians, and facilities. All procedures were compliant with the terms of the Health Insurance Portability and Accountability Act.
Results:Mean sensitivity was 85.2% (95% confi dence interval [CI]: 83.7%, 86.6%) and was signifi cantly lower for radiologists with a greater screening focus ( P = .023) but did not signifi cantly differ by total ( P = .47), screening ( P = .33), or diagnostic ( P = .23) volume. The mean false-positive rate was 9.1% (95% CI: 8.1%, 10.1%), with rates signifi cantly higher for radiologists who had the lowest total ( P = .008) and screening ( P = .015) volumes. Radiologists with low diagnostic volume ( P = .004 and P = .008) and a greater screening focus ( P = .003 and P = .002) had signifi cantly lower false-positive and cancer detection rates, respectively. Median invasive tumor size and proportion of cancers detected at early stages did not vary by volume.
Conclusion:Increasing minimum interpretive volume requirements in the United States while adding a minimal requirement for diagnostic interpretation could reduce the number of false-positive work-ups without hindering cancer detection. These results provide detailed associations between mammography volumes and performance for policymakers to consider along with workforce, practice organization, and access issues and radiologist experience when reevaluating requirements.
This study identified minimally acceptable performance levels for interpreters of screening mammography studies. Interpreting physicians whose performance falls outside the identified cut points should be reviewed in the context of their specific practice settings and be considered for additional training.
Proof of the benefit of screening mam mography can come only from randomized, controlled trials. Although proof that screen ing mammography can reduce the mortality rate from breast cancer by at least 25% for women 50 years old and older has been available since the mid 1980s [2], several is sues have delayed acceptance of the recom mendation for annual screening for women in their 40s [3]. Controversy arose when retrospective sub group analysis was used to evaluate benefit for women in their 40s separately from benefit for older women. Because the trials were not orig inally designed to study women 40â€"49years old as a cohort, none of the individual trials had sufficient statistical power in the early years offollow-up to permit proofof mortality rate benefit for this subgroup. Mets-analysis was therefore required to accumulate suffi cient numbers to permit crude analysis. Al though meta-analysis of short-term follow-up data showed no statistically significant benefit from screening women in their 40s [4], the most recent meta-analyses, using longer term follow-up, show statistically significant mor tality rate reductions of 18â€"29% for women guidelines replaced the previous recommenda tion for screening mammography every 1â€"2 years for women who are 40â€"49 years old and annual screening for women who are 50 years old and older [11.The new recommendation is justified by the more rapid growth of breast iii mors among younger women. Mammographic screening may also benefit women younger than 40 years old who are at a high risk for breast cancer. This report is a summary of the ACR Task Force on Breast Cancer review.
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