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Variation in Assessments of Breast Density on Mammograms in Clinical Practice FREE ONLINE FIRST

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The full report is titled “Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice. Findings From a Multicenter Observational Study.” The authors are B.L. Sprague, E.F. Conant, T. Onega, M.P. Garcia, E.F. Beaber, S.D. Herschorn, C.D. Lehman, A.N.A. Tosteson, R. Lacson, M.D. Schnall, D. Kontos, J.S. Haas, D.L. Weaver, and W.E. Barlow, on behalf of the PROSPR Consortium.

This article was published at www.annals.org on 19 July 2016.


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Ann Intern Med. Published online 19 July 2016 doi:10.7326/P16-9021
© 2016 American College of Physicians
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What is the problem and what is known about it so far?

Women with dense breasts are at higher risk for breast cancer. About half of the United States require that information on the density of a woman's breasts be made available to her after a mammogram, and in some states the report must also inform such women about additional tests, such as breast magnetic resonance imaging (MRI), that may detect breast cancer in women who have dense breasts and normal mammograms.

Why did the researchers do this particular study?

To see whether radiologists vary in interpreting mammograms as showing increased breast density.

Who was studied?

83 radiologists who interpreted at least 500 mammograms over 3 years in 30 different facilities that were part of 3 breast cancer research groups.

How was the study done?

Radiologist reports were reviewed for 216,783 mammograms performed on 145,123 women between the ages of 40 and 89 years who had never had a diagnosis of breast cancer and who were having a mammogram for screening (not because they had symptoms of breast cancer, such as a breast lump).

What did the researchers find?

Overall, slightly more than one third of mammograms were rated as showing increased breast density. However, the percentage of mammograms that a particular radiologist interpreted as showing increased breast density ranged widely, from about 6% to almost 85%. This variation among radiologists did not seem to be due to differences in the characteristics of the women who were examined, such as age, race, or body mass index. When women had 2 consecutive mammograms read by different radiologists, about 17% had a finding of increased breast density reported on one mammogram but not the other.

What were the limitations of the study?

The use of additional methods of determining breast density on mammograms, such as automated computer interpretation, was not determined, and the type of mammography equipment used was not analyzed.

What are the implications of the study?

The likelihood that a woman will be told that she has dense breasts on a mammogram may vary depending on which radiologist interprets her examination. Health care providers and policymakers should consider this when they make recommendations for individual patients and develop overall policies for patient notification and supplemental testing.

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