Accuracy of diagnostic mammography at facilities serving vulnerable women.
BACKGROUND
Breast cancer missed on diagnostic mammography may contribute to delayed diagnoses, whereas false-positive results may lead to unnecessary invasive procedures. Whether accuracy of diagnostic mammography at facilities serving vulnerable women differs from other facilities is unknown.


OBJECTIVE
To compare the interpretive performance of diagnostic mammography at facilities serving vulnerable women to those serving nonvulnerable women.


METHODS
We examined 168,251 diagnostic mammograms performed at Breast Cancer Surveillance Consortium facilities from 1999 to 2005. We used hierarchical logistic regression to compare sensitivity, false positive rates, and cancer detection rates.


METHODS
Women aged between 40 and 80 years underwent diagnostic mammography to evaluate an abnormal screening mammogram or breast problem.


METHODS
Facilities were assigned vulnerability indices according to the populations served based on the proportion of mammograms performed on women with lower educational attainment, racial/ethnic minority status, limited household income, or rural residences.


RESULTS
Sensitivity of diagnostic mammography did not vary significantly across vulnerability indices adjusted for patient-level characteristics, but false-positive rates for diagnostic mammography examinations to evaluate a breast problem were higher at facilities serving vulnerable women defined as those with lower educational attainment (odds ratio [OR], 1.39; 95% confidence interval [CI]: 1.08, 1.79); racial/ethnic minorities (OR, 1.32; 95% CI: 0.98, 1.76); limited income (OR, 1.34; 95% CI: 1.08, 1.66); and rural residence (OR, 1.55; 95% CI: 1.27, 1.88).


CONCLUSIONS
Diagnostic mammography to evaluate a breast problem at facilities serving vulnerable women had higher false positive rates than at facilities serving nonvulnerable women. This may reflect concerns that vulnerable populations may be less likely to follow-up after abnormal diagnostic mammography or concerns that such populations have higher cancer prevalence.
Goldman
L Elizabeth
LE
Department of Medicine, University of California San Francisco, San Francisco, CA 94110, USA. goldmanl@medicine.ucsf.edu
Walker
Rod
R
Miglioretti
Diana L
DL
Smith-Bindman
Rebecca
R
Kerlikowske
Karla
K
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D012111:Residence Characteristics; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000706:statistics & numerical data*