Diagnostic testing following screening mammography in the elderly.
BACKGROUND
To provide some sense of the general frequency and timing of diagnostic testing following screening mammography in the United States, we investigated the experience of women screened in the Medicare population.


METHODS
By use of Medicare's National Claims History System, we identified a cohort (n=23172) of women 65 years old or older screened during the period from January 1, 1995, through April 30, 1995, and tracked each woman over the subsequent 8 months for the performance of additional breast imaging and biopsy procedures. Using two claims-based definitions for newly detected breast cancer, we also estimated the positive predictive value of screening mammography.


RESULTS
For every 1000 women aged 65-69 years who underwent screening, 85 (95% confidence interval [CI]=79-91) had follow-up testing in the subsequent 8 months; 76 (95% CI=71-82) had additional breast imaging, and 23 (95% CI=20-26) had biopsy procedures. Corresponding numbers for women aged 70 years or more were similar. Some women underwent repeated examinations; 13% of those receiving diagnostic mammograms had more than one; 11% of those undergoing biopsy procedures had more than one. About half of the women who underwent a biopsy had the procedure more than 3 weeks after the imaging test upon which the decision to perform a biopsy was presumably made. The estimated positive predictive value of an abnormal screening mammogram (defined as a mammogram that engendered additional testing) was 0.08 (95% CI=0.06-0.10) for women aged 65-69 years and 0.14 (95% CI=0.12-0.16) for women aged 70 years or more.


CONCLUSIONS
Additional testing is a frequent consequence of screening mammography and may require a considerable period of time to come to closure. The need for additional testing, however, is weakly predictive of cancer.
Welch
H G
HG
Department of Veterans Affairs Medical Center, White River Junction, VT, USA.
Fisher
E S
ES
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D006278:Medicare; D011237:Predictive Value of Tests; D014481:United States