Journal
BREAST CANCER RESEARCH AND TREATMENT
Volume 100, Issue 3, Pages 309-318Publisher
SPRINGER
DOI: 10.1007/s10549-006-9252-6
Keywords
false-positive; mammography; medicare claims; older women
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Funding
- AHRQ HHS [R24HS011618] Funding Source: Medline
- NCI NIH HHS [R01CA072076, P50CA105631] Funding Source: Medline
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Background The accuracy of mammography reading varies among radiologists. We conducted a population-based assessment on radiologist variation in false-positive rates of screening mammography and its associated radiologist characteristics. Methods About 27,394 screening mammograms interpreted by 1067 radiologists were identified from a 5% non-cancer sample of Medicare claims during 1998-1999. The data were linked to the American Medical Association Masterfile to obtain radiologist characteristics. Multilevel logistic regression models were used to examine the radiologist variation in false-positive rates of screening mammography and the associated radiologist characteristics. Results Radiologists varied substantially in the false-positive rates of screening mammography (ranging from 1.5 to 24.1%, adjusting for patient characteristics). A longer time period since graduation is associated with lower false-positive rates (odds ratio [OR] for every 10 years increase: 0.87, 95% Confidence Interval [CI], 0.81-0.94) and female radiologists had higher false-positive rates than male radiologists (OR = 1.25, 95% CI, 1.05-1.49), adjusting for patient and other radiologist characteristics. The unmeasured factors contributed to about 90% of the between-radiologist variance. Conclusions Radiologists varied greatly in accuracy of mammography reading. Female and more recently trained radiologists had higher false-positive rates. The variation among radiologists was largely due to unmeasured factors, especially unmeasured radiologist factors. If our results are confirmed in further studies, they suggest that system-level interventions would be required to reduce variation in mammography interpretation.
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