title: Organized breast screening programs in Canada: effect of radiologist reading volumes on outcomes.
abstract: OBJECTIVE
  To examine retrospectively the relationship between radiologist screening program reading volumes and interpretation results.
  
  
  METHODS
  This research project was reviewed by the University of British Columbia Research Ethics Board. Informed patient consent was not required. Data were requested from Canadian provincial screening programs for the period 1988-2000. Cancer detection rates, abnormal interpretation rates, and positive predictive values (PPVs) were calculated for individual radiologists in those programs. Multivariate Poisson mixed regression models were used to examine the effect of patient age, screening examination sequence (first or subsequent screening examination), province, radiologist reading volume, and interradiologist differences on cancer detection rate, abnormal interpretation rate, and PPV.
  
  
  RESULTS
  The results of the interpretation of 1406678 screening mammograms by 304 radiologists from seven provincial programs were analyzed. Cancer detection rate, abnormal interpretation rate, and PPV all varied according to age of woman screened and screening sequence and across the sample of radiologists. None of the rates varied by province. Neither the cancer detection rate nor the abnormal interpretation rate varied by reading volume, but the average PPV was increased by 34% for volumes over 2000 mammograms versus volumes of 480-699 mammograms per year. There was no evidence that the magnitude of variability around the average, for radiologists reading the same volume of mammograms, varied across different volume groups for any of the outcome measures.
  
  
  CONCLUSIONS
  Cancer detection did not vary with reading volume. The average PPV for individual radiologists increased as reading volume rose up to 2000 mammograms per year; it stabilized at higher volumes.
authors.affiliation: Population and Preventive Oncology, British Columbia Cancer Agency, Vancouver, Canada. acoldman@bccancer.bc.ca
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Coldman
authors.forename: Diane
authors.initials: D
authors.lastname: Major
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Doyle
authors.forename: Yulia
authors.initials: Y
authors.lastname: D'yachkova
authors.forename: Norm
authors.initials: N
authors.lastname: Phillips
authors.forename: Jay
authors.initials: J
authors.lastname: Onysko
authors.forename: Rene
authors.initials: R
authors.lastname: Shumak
authors.forename: Norah E
authors.initials: NE
authors.lastname: Smith
authors.forename: Nancy
authors.initials: N
authors.lastname: Wadden
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008403:Mass Screening / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D011871:Radiology / Q000592:standards*; D012189:Retrospective Studies; D016526:Workload