title: Influence of annual interpretive volume on screening mammography performance in the United States.
abstract: OBJECTIVE
  To examine whether U.S. radiologists' interpretive volume affects their screening mammography performance.
  
  
  METHODS
  Annual interpretive volume measures (total, screening, diagnostic, and screening focus [ratio of screening to diagnostic mammograms]) were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783 965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year. BCSC registries and the Statistical Coordinating Center received institutional review board approval for active or passive consenting processes and a Federal Certificate of Confidentiality and other protections for participating women, physicians, and facilities. All procedures were compliant with the terms of the Health Insurance Portability and Accountability Act.
  
  
  RESULTS
  Mean sensitivity was 85.2% (95% confidence interval [CI]: 83.7%, 86.6%) and was significantly lower for radiologists with a greater screening focus (P = .023) but did not significantly differ by total (P = .47), screening (P = .33), or diagnostic (P = .23) volume. The mean false-positive rate was 9.1% (95% CI: 8.1%, 10.1%), with rates significantly higher for radiologists who had the lowest total (P = .008) and screening (P = .015) volumes. Radiologists with low diagnostic volume (P = .004 and P = .008) and a greater screening focus (P = .003 and P = .002) had significantly lower false-positive and cancer detection rates, respectively. Median invasive tumor size and proportion of cancers detected at early stages did not vary by volume.
  
  
  CONCLUSIONS
  Increasing minimum interpretive volume requirements in the United States while adding a minimal requirement for diagnostic interpretation could reduce the number of false-positive work-ups without hindering cancer detection. These results provide detailed associations between mammography volumes and performance for policymakers to consider along with workforce, practice organization, and access issues and radiologist experience when reevaluating requirements.
authors.affiliation: Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA. buist.d@ghc.org
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Anderson
authors.forename: Sebastien J P A
authors.initials: SJ
authors.lastname: Haneuse
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.forename: Robert A
authors.initials: RA
authors.lastname: Smith
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
authors.forename: Robert D
authors.initials: RD
authors.lastname: Rosenberg
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Onega
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Monsees
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Bassett
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Yankaskas
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity