title: Improving Screening Mammography Outcomes Through Comparison With Multiple Prior Mammograms.
abstract: The objective of the present study is to evaluate the effect of comparison with multiple prior mammograms on the outcomes of screening mammography relative to comparison with a single prior mammogram.
  
  
  
  We retrospectively analyzed 46,288 consecutive screening mammograms performed at our institution for 22,792 women. We divided these examinations into three groups: those interpreted without comparison with prior mammograms, those interpreted in comparison with one prior examination, and those interpreted in comparison with two or more prior examinations. For each group, we determined the rate of examination recall. We also calculated the positive predictive value of recall (i.e., positive predictive value level 1 [PPV1]) and the cancer detection rate (CDR) for both the group of examinations compared with a single prior mammogram and the group compared with multiple prior mammograms. Generalized estimating equations with the logistic link function were used to determine the relative odds ratio of recall as a function of the number of comparisons, with adjustment made for age as a confounding variable. The Fisher exact test was performed to compare the PPV1 and the CDR in the different cohorts.
  
  
  
  The recall rate for mammograms interpreted without comparison with prior examinations was 16.6%, whereas that for mammograms compared with one prior examination was 7.8% and that for mammograms compared with two or more prior examinations was 6.3%. After adjustment was made for age, the odds ratio of recall for the group with multiple prior examinations relative to the group with a single prior examination was 0.864 (95% CI, 0.776-0.962; p = 0.0074). Statistically significant increases in the PPV1 of 0.05 (p = 0.0009) and in the CDR of 2.3 cases per 1000 examinations (p = 0.0481) were also noted for mammograms compared with multiple prior examinations relative to those compared with a single prior examination.
  
  
  
  Comparison with two or more prior mammograms resulted in a statistically significant reduction in the screening mammography recall rate and increases in the CDR and PPV1 relative to comparison with a single prior mammogram.
authors.affiliation: 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Divisadero St, Rm C250, Mail Box 1667, San Francisco, CA 94115.
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Hayward
authors.affiliation: 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Divisadero St, Rm C250, Mail Box 1667, San Francisco, CA 94115.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Ray
authors.affiliation: 2 Kaiser San Rafael Medical Center, San Rafael, CA.
authors.forename: Dorota J
authors.initials: DJ
authors.lastname: Wisner
authors.affiliation: 3 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
authors.forename: John
authors.initials: J
authors.lastname: Kornak
authors.affiliation: 4 Jambeyang Research, LCC, Cupertino, CA.
authors.forename: Weiwen
authors.initials: W
authors.lastname: Lin
authors.affiliation: 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Divisadero St, Rm C250, Mail Box 1667, San Francisco, CA 94115.
authors.forename: Bonnie N
authors.initials: BN
authors.lastname: Joe
authors.affiliation: 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1600 Divisadero St, Rm C250, Mail Box 1667, San Francisco, CA 94115.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
keywords: cancer detection; mammography; recall rate; screening