Breast cancer yield for screening mammographic examinations with recommendation for short-interval follow-up.
OBJECTIVE
To compare cancer yield for screening examinations with recommendation for short-interval follow-up after diagnostic imaging work-up versus after screening mammography only.


METHODS
From January 1996 to December 1999, Breast Imaging Reporting and Data System assessments and recommendations were collected prospectively for 1,171,792 screening examinations in 758,015 women aged 40-89 years at seven mammography registries in Breast Cancer Surveillance Consortium. Registries obtained waiver of signed consent or collected signed consent in accordance with institutional review boards at each location. Diagnosis of invasive cancer or ductal carcinoma in situ within 24 months of screening examination and tumor stage and size for invasive cancer were determined through linkage to pathology database or tumor registry. chi2 test was used to determine significant differences between groups.


RESULTS
Overall, 5.2% of first and 1.7% of subsequent screens included recommendation for short-interval follow-up, which was similar to likelihood of recommendation for diagnostic evaluation (first screens, 4.6%; subsequent, 2.6%). Most recommendations for short-interval follow-up were based on screening mammography alone (86.2% of first screens, 77.5% of subsequent). Yield of cancer for screening examinations with probably benign finding (PBF) and recommendation for short-interval follow-up based on screening mammography alone tended to be lower than in those with PBF and recommendation for short-interval follow-up after additional work-up (first screens: 0.54% vs 0.96%, P=.10; subsequent: 1.50% vs 1.73%, P=.26). Proportion of stage II and higher disease tended to be higher for examinations with PBF and recommendation for short-interval follow-up based on screening mammography alone compared with those recommended for short-interval follow-up after additional work-up (first screens: 34.7% vs 24.4%, P=.43; subsequent: 27.5% vs 19.2%, P=.13).


CONCLUSIONS
Many first screening examinations include recommendation for short-interval follow-up based on screening mammography alone. Cancer yield for these examinations is low and is lower than that with diagnostic work-up prior to short-interval follow-up recommendation. Absence of diagnostic work-up prior to short-interval follow-up recommendation may result in periodic surveillance of a high proportion of benign lesions.
Kerlikowske
Karla
K
Dept of Medicine and Epidemiology and Biostatistics, Univ of California, San Francisco, CA 94121, USA. kerliko@itsa.ucsf.edu
Smith-Bindman
Rebecca
R
Abraham
Linn A
LA
Lehman
Constance D
CD
Yankaskas
Bonnie C
BC
Ballard-Barbash
Rachel
R
Barlow
William E
WE
Voeks
Jennifer H
JH
Geller
Berta M
BM
Carney
Patricia A
PA
Sickles
Edward A
EA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000453:epidemiology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors