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Purpose To establish contemporary performance benchmarks for diagnostic digital mammography using recent data from the Breast Cancer Surveillance Consortium. Materials and Methods Institutional review board approval was obtained for active or passive consenting processes or a waiver of consent to enroll participants, link data, and perform analyses. This study included data from six Breast Cancer Surveillance Consortium registries (418 radiologists; 92 radiology facilities). Mammogram indication and assessments were prospectively collected on women undergoing diagnostic digital mammography and linked with cancer diagnoses from state cancer registries. We included 401,548 examinations conducted during 2007–2013 on 265,360 women. Results Overall diagnostic performance measures were the following: cancer detection rate, 34.7 per 1000 (95% CI: 34.1, 35.2); abnormal interpretation rate, 12.6% (95% CI: 12.5, 12.7); positive predictive value (PPV)-2, 27.5% (27.1, 27.9); PPV-3, 30.4% (95% CI: 29.9, 30.9); false negative rate, 4.8 per 1000 (95% CI: 4.6, 5.0); sensitivity, 87.8% (95% CI: 87.3, 88.4); specificity, 90.5% (95% CI: 90.4, 90.6). Among cancers detected, 63.4% were cancers stage 0 or 1; 45.6% were minimal cancers; the mean size of invasive cancers was 21.2 mm; and 69.6% of invasive cancers were node negative. Performance metrics varied widely across diagnostic indications with cancer detection rate (64.5 per 1000) and abnormal interpretation rate (18.7%) highest for diagnostic mammograms to evaluate a breast problem with a lump. Compared to the film mammography era, diagnostic digital performance showed increased abnormal interpretation and cancer detection rates and declining PPVs, with less than 70% of radiologists within acceptable ranges for PPV2 and PPV3. Conclusion These performance measures can serve as national benchmarks that may help to transform the marked variation in radiologists’ diagnostic performance into targeted quality improvement efforts.

Background: The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. Methods: Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience. Results: The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic. Conclusions: This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.

BackgroundMammographic breast density is a well-established strong risk factor for breast cancer. The environmental contributors to geographic variation in breast density in urban and rural areas are poorly understood. We examined the association between breast density and exposure to ambient air pollutants (particulate matter <2.5 μm in diameter (PM2.5) and ozone (O3)) in a large population-based screening registry.MethodsParticipants included women undergoing mammography screening at imaging facilities within the Breast Cancer Surveillance Consortium (2001–2009). We included women aged ≥40 years with known residential zip codes before the index mammogram (n = 279,967). Breast density was assessed using the American College of Radiology’s Breast Imaging-Reporting and Data System (BI-RADS) four-category breast density classification. PM2.5 and O3 estimates for grids across the USA (2001–2008) were obtained from the US Environmental Protection Agency Hierarchical Bayesian Model (HBM). For the majority of women (94%), these estimates were available for the year preceding the mammogram date. Association between exposure to air pollutants and density was estimated using polytomous logistic regression, adjusting for potential confounders.ResultsWomen with extremely dense breasts had higher mean PM2.5 and lower O3 exposures than women with fatty breasts (8.97 vs. 8.66 ug/m3 and 33.70 vs. 35.82 parts per billion (ppb), respectively). In regression analysis, women with heterogeneously dense vs. scattered fibroglandular breasts were more likely to have higher exposure to PM2.5 (fourth vs. first quartile odds ratio (OR) = 1.19, 95% confidence interval (CI) 1.16 − 1.23). Women with extremely dense vs. scattered fibroglandular breasts were less likely to have higher levels of ozone exposure (fourth vs. first quartile OR = 0.80, 95% CI 0.73–0.87).ConclusionExposure to PM2.5 and O3 may in part explain geographical variation in mammographic density. Further studies are warranted to determine the causal nature of these associations.

IMPORTANCE Whole-breast ultrasonography has been advocated to supplement screening mammography to improve outcomes in women with dense breasts. OBJECTIVE To determine the performance of screening mammography plus screening ultrasonography compared with screening mammography alone in community practice. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study. Two Breast Cancer Surveillance Consortium registries provided prospectively collected data on screening mammography with vs without same-day breast ultrasonography from January 1, 2000, to December 31, 2013. The dates of analysis were March 2014 to December 2018. A total of 6081 screening mammography plus same-day screening ultrasonography examinations in 3386 women were propensity score matched 1:5 to 30 062 screening mammograms without screening ultrasonography in 15 176 women from a sample of 113 293 mammograms. Exclusion criteria included a personal history of breast cancer and self-reported breast symptoms. EXPOSURES Screening mammography with vs without screening ultrasonography. MAIN OUTCOMES AND MEASURES Cancer detection rate and rates of interval cancer, false-positive biopsy recommendation, short-interval follow-up, and positive predictive value of biopsy recommendation were estimated and compared using log binomial regression. RESULTS Screening mammography with vs without ultrasonography examinations was performed more often in women with dense breasts (74.3% [n = 4317 of 5810] vs 35.9% [n = 39 928 of 111 306] in the overall sample), in women who were younger than 50 years (49.7% [n = 3022 of 6081] vs 31.7% [n = 16 897 of 112 462]), and in women with a family history of breast cancer (42.9% [n = 2595 of 6055] vs 15.0% [n = 16 897 of 112 462]). While 21.4% (n = 1154 of 5392) of screening ultrasonography examinations were performed in women with high or very high (Ն2.50%) Breast Cancer Surveillance Consortium 5-year risk scores, 53.6% (n = 2889 of 5392) had low or average (<1.67%) risk. Comparing mammography plus ultrasonography with mammography alone, the cancer detection rate was similar at 5.4 vs 5.5 per 1000 screens (adjusted relative risk [RR], 1.14; 95% CI, 0.76-1.68), as were interval cancer rates at 1.5 vs 1.9 per 1000 screens (RR, 0.67; 95% CI, 0.33-1.37). The false-positive biopsy rates were significantly higher at 52.0 vs 22.2 per 1000 screens (RR, 2.23; 95% CI, 1.93-2.58), as was short-interval follow-up at 3.9% vs 1.1% (RR, 3.10; 95% CI, 2.60-3.70). The positive predictive value of biopsy recommendation was significantly lower at 9.5% vs 21.4% (RR, 0.50; 95% CI, 0.35-0.71). CONCLUSIONS AND RELEVANCE In a relatively young population of women at low, intermediate, and high breast cancer risk, these results suggest that the benefits of supplemental ultrasonography screening may not outweigh associated harms.

Background Increase in breast cancer incidence associated with mammography screening diffusion may have attenuated risk associations between family history and breast cancer. Methods The proportions of women aged 40–74 years reporting a first-degree family history of breast cancer were estimated in the Breast Cancer Surveillance Consortium cohort (BCSC, N=1,170,900; 1996–2012) and the Collaborative Breast Cancer Study (CBCS; cases N=23,400; controls N=26,460; 1987–2007). Breast cancer (ductal carcinoma in situ and invasive) relative risk estimates and 95% confidence intervals (CI) associated with family history were calculated using multivariable Cox proportional hazard and logistic regression models. Results The proportion of women reporting a first-degree family history increased from 11% in the 1980s to 16% in 2010–13. Family history was associated with a >60% increased risk of breast cancer in the BCSC (hazard ratio=1.61;95%CI=1.55–1.66) and CBCS (odds ratio=1.64;95%CI=1.57–1.72). Relative risks decreased slightly with age. Consistent trends in relative risks were not observed over time or across stage of disease at diagnosis in both studies, except among older women (60–74) where estimates were attenuated from about 1.7 to 1.3 over the last 20 years (P-trend=0.08 for both studies). Conclusion Although the proportion of women with a first-degree family history of breast cancer increased over time and by age, breast cancer risk associations with family history were nonetheless fairly constant over time for women under age 60. Implication First-degree family history of breast cancer remains an important breast cancer risk factor, especially for younger women, despite its increasing prevalence in the mammography screening era.

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A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.