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Importance of Diagnostic Mammography: Benchmarks & Impact

This article discusses the importance of diagnostic mammography screening and the benchmarks used to assess its performance. It explores the benefits and harms of mammography screening, including anxiety, inconvenience, resources, and costs. The article also emphasizes the need to monitor and assess both screening and diagnostic mammography performance.

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Importance of Diagnostic Mammography: Benchmarks & Impact

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  1. Clinical Diagnostic Mammography Benchmarks Edward A. Sickles, M.D.

  2. Importance of Diagnostic Mammography Screening: recall versus no recall Diagnostic: biopsy versus no biopsy

  3. Importance of Diagnostic Mammography Screening: recall versus no recall Diagnostic: biopsy versus no biopsy Screening: who gets diagnostic Dxic: “where the rubber meets the road”

  4. Importance of Diagnostic Mammography Benefits: screening ≈ diagnostic

  5. Importance of Diagnostic Mammography Benefits: screening ≈ diagnostic Harms: screening << diagnostic

  6. Harms of Mammography Screening Anxiety Inconvenience Resources Cost

  7. Harms of Mammography Screening Diagnostic Anxiety Inconvenience Resources Cost

  8. Harms of Mammography Screening Diagnostic Anxiety More anxiety Inconvenience Resources Cost

  9. Harms of Mammography Screening Diagnostic Anxiety More anxiety Inconvenience More inconvenience Resources Cost

  10. Harms of Mammography Screening Diagnostic Anxiety More anxiety Inconvenience More inconvenience Resources More resources Cost

  11. Harms of Mammography Screening Diagnostic Anxiety More anxiety Inconvenience More inconvenience Resources More resources Cost More costs

  12. Harms of Mammography Screening Diagnostic Anxiety More anxiety Inconvenience More inconvenience Resources More resources Cost More costs “Overdiagnosis”

  13. In the USA, mammography practice is opportunistic not organized, delivered locally not regionally or nationally.

  14. In the USA, mammography practice is opportunistic not organized, delivered locally not regionally or nationally. The same physicians interpret both screening & diagnostic mammography.

  15. The same physicians interpret both screening & diagnostic mammography.

  16. Dxic: “where the rubber meets the road” The same physicians interpret both screening & diagnostic mammography.

  17. Dxic: “where the rubber meets the road” Harms: screening << diagnostic The same physicians interpret both screening & diagnostic mammography.

  18. Hence the crucial importance in monitoring and assessing not only screening but also diagnostic mammography performance

  19. How to Assess Mammo Performance Observed performance outcomes are compared to standard performance parameters that have been designated as acceptable.

  20. AJR 2001; 176:729-733

  21. Diagnostic Examinations Additional work-up of abnormal screening Short-interval (6-month) follow-up Evaluation of a breast problem - Palpable mass - Other breast problem

  22. Performance benchmarks derived from audits of very large numbers of exams interpreted by a “population-based sample” of U.S. radiologists

  23. Radiology 2005; 235:775-790

  24. Abnormal Interpretation Rate: 1996-2002 112,917 Exams 97,123 Exams 99,737 Exams 72,307 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  25. PPV2 (Biopsy Recommended): 1996-2002 112,917 Exams 97,123 Exams 99,737 Exams 72,307 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  26. PPV3 (Biopsy Performed): 1996-2002 112,917 Exams 97,123 Exams 99,737 Exams 72,307 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  27. Cancer Diagnosis Rate: 1996-2002 105,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  28. Mean Invasive Cancer Size: 1996-2002 105,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  29. Percent Minimal Cancer: 1996-2002 105,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  30. Percent Node Negative: 1996-2002 105,378 Exams 88,750 Exams 88,750 Exams 90,318 Exams 62,793 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  31. Percent Stage 0 or I: 1996-2002 105,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  32. 5th Edition

  33. BI-RADS 5th Edition: BCSC Contributions Separate screening / diagnostic audits 6 of 15 “see more” reference citations Elimination of percent density guidance Revised definition for cat. 3 at screening Angoff-consensus screening cut points Updated plots of all measured outcomes

  34. Cancer Diagnosis Rate: 1996-2002 105,378 Exams 88,750 Exams 90,318 Exams 62,793 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

  35. Cancer Diagnosis Rate: 1996-2005 176,943 Exams 137,639 Exams 160,189 Exams 92,764 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

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