title: Time trends in radiologists' interpretive performance at screening mammography from the community-based Breast Cancer Surveillance Consortium, 1996-2004.
abstract: OBJECTIVE
  To examine time trends in radiologists' interpretive performance at screening mammography between 1996 and 2004.
  
  
  METHODS
  All study procedures were institutional review board approved and HIPAA compliant. Data were collected on subsequent screening mammograms obtained from 1996 to 2004 in women aged 40-79 years who were followed up for 1 year for breast cancer. Recall rate, sensitivity, and specificity were examined annually. Generalized estimating equation (GEE) and random-effects models were used to test for linear trend. The area under the receiver operating characteristic curve (AUC), tumor histologic findings, and size of the largest dimension or diameter of the tumor were also examined.
  
  
  RESULTS
  Data on 2,542,049 subsequent screening mammograms and 12,498 cancers diagnosed in the follow-up period were included in this study. Recall rate increased from 6.7% to 8.6%, sensitivity increased from 71.4% to 83.8%, and specificity decreased from 93.6% to 91.7%. In GEE models, adjusted odds ratios per calendar year were 1.04 (95% confidence interval [CI]: 1.02, 1.05) for recall rate, 1.09 (95% CI: 1.07. 1.12) for sensitivity, and 0.96 (95% CI: 0.95, 0.98) for specificity (P < .001 for all). Random-effects model results were similar. The AUC increased over time: 0.869 (95% CI: 0.861, 0.877) for 1996-1998, 0.884 (95% CI: 0.879, 0.890) for 1999-2001, and 0.891 (95% CI: 0.885, 0.896) for 2002-2004 (P < .001). Tumor histologic findings and size remained constant.
  
  
  CONCLUSIONS
  Recall rate and sensitivity for screening mammograms increased, whereas specificity decreased from 1996 to 2004 among women with a prior mammogram. This trend remained after accounting for risk factors. The net effect was an improvement in overall discrimination, a measure of the probability that a mammogram with cancer in the follow-up period has a higher Breast Imaging Reporting and Data System assessment category than does a mammogram without cancer in the follow-up period.
authors.affiliation: Group Health Research Institute, Suite 1600, Seattle, WA 98101, USA. ichikawa.l@ghc.org
authors.forename: Laura E
authors.initials: LE
authors.lastname: Ichikawa
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
authors.forename: R James
authors.initials: RJ
authors.lastname: Brenner
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D013997:Time Factors; D014481:United States / Q000453:epidemiology