Clinical Image Quality and Sensitivity in an Organized Mammography Screening Program

Théberge, Isabelle; Guertin, Marie-Hélène; Vandal, Nathalie; Daigle, Jean-Marc; Dufresne, Michel-Pierre; Wadden, Nancy; Shumak, Rene; Samson, Crystal; Langlois, André; Larocque, Isabelle; Perron, Linda; Pelletier, Éric; Brisson, Jacques

doi:10.1016/j.carj.2017.09.002

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…Programme sensitivity is stable (65.1% in 2014) but lower than in other countries such as Germany (78.2%) [17], the Netherlands (74.4%) [18], Norway (75.5%) [19], or Canada (68%) [20]. Closer inspection reveals that the categorization of BC as either SDC or interval cancers differs between programmes.…”

Section: Discussionmentioning

confidence: 99%

“…Closer inspection reveals that the categorization of BC as either SDC or interval cancers differs between programmes. For instance, in the German programme any BC found within 24 months after a positive screening was considered an SDC, while the Canadian Programme only considered a BC as screen detected if they were found within 6 months after a positive screening [17, 20]. The Canadian programme will thus classify certain BC as interval cancers, while the German programme would see them as SDC.…”

Section: Discussionmentioning

confidence: 99%

“…The Flemish PMSP only considers a BC as screen detected if it was found within 3 months after the first diagnostic assessment that follows a positive screening (see also Table 2) [21]. The Canadian definition of an SDC is relatively close to the Flemish, which might explain why their programme sensitivity is similar (68% in Canada, 65.1% in Flanders) [20].…”

Section: Discussionmentioning

confidence: 99%

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Flemish breast cancer screening programme: 15 years of key performance indicators (2002–2016)

Goossens

Brabander²,

Grève

et al. 2019

BMC Cancer

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BackgroundWe examined 15 years of key performance indicators (KPIs) of the population-based mammography screening programme (PMSP) in Flanders, Belgium.MethodsIndividual screening data were linked to the national cancer registry to obtain oncological follow-up. We benchmarked crude KPI results against KPI-targets set by the European guidelines and KPI results of other national screening programmes. Temporal trends were examined by plotting age-standardised KPIs against the year of screening and estimating the Average Annual Percentage Change (AAPC).ResultsPMSP coverage increased significantly over the period of 15 years (+ 7.5% AAPC), but the increase fell to + 1.6% after invitation coverage was maximised. In 2016, PMSP coverage was at 50.0% and opportunistic coverage was at 14.1%, resulting in a total coverage by screening of 64.2%. The response to the invitations was 49.8% in 2016, without a trend. Recall rate decreased significantly (AAPC -1.5% & -5.0% in initial and subsequent regular screenings respectively) while cancer detection remained stable (AAPC 0.0%). The result was an increased positive predictive value (AAPC + 3.8%). Overall programme sensitivity was stable and was at 65.1% in 2014.In initial screens of 2015, the proportion of DCIS, tumours stage II+, and node negative invasive cancers was 18.2, 31.2, and 61.6% respectively. In subsequent regular screens of 2015, those proportions were 14.0, 24.8, and 65.4% respectively. Trends were not significant.ConclusionBesides a suboptimal attendance rate, most KPIs in the Flemish PMSP meet EU benchmark targets. Nonetheless, there are several priorities for further investigation such as a critical evaluation of strategies to increase screening participation, organising a biennial radiological review of interval cancers, analysing the effect that preceding opportunistic screening has on the KPI for initial screenings, and efforts to estimate the impact on breast cancer mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Flemish breast cancer screening programme: 15 years of key performance indicators (2002–2016)

Goossens

Brabander²,

Grève

et al. 2019

BMC Cancer

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“…The study sample was described in our previous paper [11]. Briefly, the study was based on a random sample of 481 invasive screen-detected cancers (48% of the 1006 screen-detected cancers) and all 481 invasive interval cancers diagnosed following a film-screen mammogram performed within the PQDCS in 2007.…”

Section: Methodsmentioning

confidence: 99%

Screening Sensitivity According to Breast Cancer Location

et al. 2019

Self Cite

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Purpose To examine the relation between breast cancer location and screening mammogram sensitivity, and assess whether this association is modified by body mass index (BMI) or breast density. Methods This study is based on all interval cancers (n = 481) and a random sample of screen-detected cancers (n = 481) diagnosed in Quebec Breast Cancer Screening Program participants in 2007. Film-screening mammograms, diagnostic mammograms, and ultrasound reports (when available) were requested for these cases. The breast cancer was then localised in mediolateral oblique (MLO) and craniocaudal (CC) projections of the breast by 1 experienced radiologist. The association between cancer location and screening sensitivity was assessed by logistic regression. Adjusted sensitivity and sensitivity ratios were obtained by marginal standardisation. Results A total of 369 screen-detected and 268 interval cancers could be localised in MLO and/or CC projections. The 2-year sensitivity reached 68%. Overall, sensitivity was not statistically associated with location of the cancer. However, sensitivity seems lower in MLO posterior inferior area for women with BMI ≥ 25 kg/m2 compared to sensitivity in central area for women with lower BMI (adjusted sensitivity ratio: 0.58, 95% confidence interval [CI]: 0.17–0.98). Lower sensitivity was also observed in subareolar areas for women with breast density ≥ 50% compared to the central areas for women with lower breast density (for MLO and CC projections, adjusted sensitivity ratio and 95% CI of, respectively, 0.54 [0.13–0.96] and 0.46 [0.01–0.93]). Conclusions Screening sensitivity seems lower in MLO posterior inferior area in women with higher BMI and in subareolar areas in women with higher breast density. When interpreting screening mammograms, radiologists need to pay special attention to these areas.

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“…In these studies, improper breast positioning was the most common factor affecting the quality of mammographic examinations, with failure rates of 22.6%, 37.2% and 55.0%, respectively. 5,8,19 There is some evidence suggesting that quality monitoring of mammographic examinations and up-to-date positioning training, rather than the technologist's years of experience, lead to higher quality images. In a Dutch study, newly trained technologists were more likely to demonstrate adequate breast positioning than experienced technologists (97% v. 86%, respectively, for CC views and 92% v. 84%, respectively, for MLO views).…”

Section: Researchmentioning

confidence: 99%

Evaluation of the quality of mammographic breast positioning: a quality improvement study

Rouette

Elfassy

Bouganim

et al. 2021

cmajo

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Competing interests: Julie Rouette has received consulting fees from Biogen for work unrelated to this study. Nathaniel Bouganim has received consulting fees from Amgen, Novartis and Roche for work unrelated to this study. Nathaniel Lasry is a shareholder of iMD Research, which received a contract to assist with the design of the professional inspection of technologists from the Ordre des technologues en imagerie médicale, en radio-oncologie et en électrophysiologie médicale du Québec. Laurent Azoulay has received consulting fees from Janssen and Pfizer for work unrelated to this study. No other competing interests were declared. This article has been peer reviewed.

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Clinical Image Quality and Sensitivity in an Organized Mammography Screening Program

Cited by 13 publications

References 22 publications

Flemish breast cancer screening programme: 15 years of key performance indicators (2002–2016)

Flemish breast cancer screening programme: 15 years of key performance indicators (2002–2016)

Screening Sensitivity According to Breast Cancer Location

Evaluation of the quality of mammographic breast positioning: a quality improvement study

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