title: Screening mammography: clinical image quality and the risk of interval breast cancer.
abstract: OBJECTIVE
  We evaluated the association between clinical image quality and breast cancer occurrence within 24 months of a negative mammogram.
  
  
  METHODS
  We identified women with breast cancer who were younger than 40 years old and older and screened from January 1, 1988, through December 31, 1993. We retrospectively assigned Breast Imaging Reporting and Data System (BI-RADS) assessments to their screening mammogram. We classified cancers (invasive or ductal in situ) as "screen-detected" when found after positive assessments (BI-RADS codes 3, 4, and 5) and "interval-detected" when found after negative assessments (BI-RADS codes 1 and 2). One reviewer evaluated mediolateral oblique and craniocaudal views for all cancer cases using a 3-point scale (failure, borderline, pass) for each measure of clinical image quality (positioning, breast compression, contrast, exposure, noise, sharpness, artifacts, overall quality). We used separate logistic regression models and evaluated the odds of interval invasive cancer or invasive plus in situ cancer as a function of each measure of quality using "pass" as the referent group.
  
  
  RESULTS
  We found 492 screen-detected and 164 interval-detected cancers that met study criteria. Cancer detection (sensitivity) was highest (84%) among patients with proper breast positioning, but when images failed this measure (33.4%), sensitivity fell to 66.3%. After adjustment for age, film date, and breast density, interval-detected invasive cancers were more likely after images failing positioning (odds ratio, 2.57; 95% confidence interval, 1.28-5.52%). Failures in overall quality were also associated with interval cancers when cases of ductal carcinoma in situ (p = 0.037) were included.
  
  
  CONCLUSIONS
  Invasive breast cancer detection by mammography may be improved through attention to correct positioning.
authors.affiliation: Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Ste. 1600, Seattle, WA 98101, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.forename: Charles
authors.initials: C
authors.lastname: Finder
authors.forename: Margaret T
authors.initials: MT
authors.lastname: Mandelson
authors.forename: Florence
authors.initials: F
authors.lastname: Houn
authors.forename: Emily
authors.initials: E
authors.lastname: White
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002277:Carcinoma / Q000000981:diagnostic imaging; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D011786:Quality Control; D012189:Retrospective Studies; D012680:Sensitivity and Specificity