title: Effects of digital mammography uptake on downstream breast-related care among older women.
abstract: BACKGROUND
  Digital mammography is the dominant modality for breast cancer screening in the United States. No previous studies have investigated as to how introducing digital mammography affects downstream breast-related care.
  
  
  OBJECTIVE
  Compare breast-related health care use after a screening mammogram before and after introduction of digital mammography.
  
  
  METHODS
  Longitudinal study of screening mammograms from 14 radiology facilities contributing data to the Breast Cancer Surveillance Consortium performed 1 year before and 4 years after each facility introduced digital mammography, along with linked Medicare claims. We included 30,211 mammograms for women aged 66 years and older without breast cancer.
  
  
  METHODS
  Rates of false-positive recall and short-interval follow-up were based on radiologists' assessments and recommendations; rates of follow-up mammography, ultrasound, and breast biopsy use were based on Medicare claims.
  
  
  RESULTS
  False-positive recall rates increased after the introduction of digital mammography. Follow-up mammography use was significantly higher across all 4 years after a facility began using digital mammography compared with the year before [year 1 odds ratio (OR) = 1.7, 95% confidence interval (CI), 1.4-2.1]. Among women with false-positive mammography results, use of ultrasound decreased significantly in the second through fourth years after digital mammography began (year 2 OR = 0.4, 95% CI, 0.3-0.6).
  
  
  CONCLUSIONS
  Introduction of a new technology led to changes in health care use that persisted for at least 4 years. Comparative effectiveness research on new technologies should consider not only diagnostic performance but also downstream utilization attributable to this apparent learning curve.
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA. hubbard.r@ghc.org
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhu
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Onega
authors.forename: Paul
authors.initials: P
authors.lastname: Fishman
authors.forename: Louise M
authors.initials: LM
authors.lastname: Henderson
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis; D057186:Comparative Effectiveness Research; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008327:Mammography / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D014481:United States