Analysis of Participant Factors That Affect the Diagnostic Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea

• Published in: Korean journal of radiology Vol. 18; no. 4; pp. 624 - 631
• Main Authors: Kim, Young Joong, Lee, Eun Hye, Jun, Jae Kwan, Shin, Dong-Rock, Park, Young Mi, Kim, Hye-Won, Kim, Youme, Kim, Keum Won, Lim, Hyo Soon, Park, Jeong Seon, Kim, Hye Jung, Jo, Hye-Mi
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01-07-2017; 대한영상의학회
• Subjects: Adult; Age groups; Aged; Breast cancer; Breast Density; Breast Imaging; Breast Neoplasms - diagnosis; Breast Neoplasms - diagnostic imaging; Business metrics; Databases, Factual; Early Detection of Cancer; Female; Humans; Mammography; Medical screening; Middle Aged; Republic of Korea; Sensitivity and Specificity; Trends; 방사선과학; United States > US; Audit; National mammography database; Screening mammography; Cancer detection rates
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2017.18.4.624

To analyze participant factors that affect the diagnostic performance of screening mammography.
We enrolled 128756 cases from 10 hospitals between 2005 and 2010. We analyzed recall rate, cancer detection rate (CDR) per 1000 examinations, positive predictive value (PPV), sensitivity, specificity, false positive rate (FPR), and interval cancer rate (ICR) per 1000 negative examinations according to participant factors including age, breast density, and number of visit to the same institution, and adjusted for confounding variables.
Increasing age improved recall rates (27.4% in 40's, 17.5% in 50's, 11.1% in 60's, and 8.6% in 70's), CDR (2.7, 3.2, 2.0, and 2.4), PPV (1.0, 1.8, 1.8, and 2.8%), sensitivity (81.3, 88.8, 90.3, and 94.7%), specificity (72.7, 82.7, 89.0, and 91.7%), and FPR (27.3, 17.3, 11.0, and 8.4%) (
< 0.05). Higher breast density impaired recall rates (4.0% in P1, 9.0% in P2, 28.9% in P3, and 27.8% in P4), PPV (3.3, 2.3, 1.2, and 1.3%), specificity (96.1, 91.2, 71.4, and 72.5%), and FPR (3.9, 8.9, 28.6, and 27.6%) (
< 0.001). It also increased CDR (1.3, 2.1, 3.3, and 3.6) and ICR (0.2, 0.3, 0.6, and 1.6) (
< 0.05). Successive visits to the same institution improved recall rates (20.9% for one visit, 10.7% for two visits, 7.7% for more than three visits), PPV (1.6, 2.8, and 2.7%), specificity (79.4, 89.6, and 92.5%), and FPR (20.6, 10.4, and 7.5%) (
< 0.001).
Young age and dense breasts negatively affected diagnostic performance in mammography screening, whereas successive visits to the same institution had a positive effect. Examinee education for successive visits to the same institution would improve the diagnostic performance.