Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation Based on Risk of Recall
Prioritizing immediate interpretation of screening mammograms for women without a mammogram in prior 5 years reduces potential harms of screening.
In a new BCSC study published in the Journal of the American College of Radiology, researchers analyzed 2,674,051 screening mammograms from 925,777 women aged 18–89 years from 2012 to 2020 interpreted by 644 radiologists at 126 radiology facilities and resulted in 235,569 recalls. The study found that time since prior mammogram and age were the most important risk factors associated with high and very high risk of being recalled for additional workup regardless of facility-level characteristics. Recall rates were very high (21.3/100) for baseline mammograms and for women with five or more years since their prior mammogram (15.1/100). Women aged 50-years or younger and women with dense breasts also experienced increased recall rates.
Findings from the study suggest that facilities with capacity to offer immediate screening mammography interpretation for 25% of screening mammograms and preference for simple rules could schedule all baseline mammograms, women with 5 or more years since their previous mammogram, and all women age <50 to account for 40% of recalls, thereby averting a substantial portion of women being recalled for diagnostic imaging at a follow-up visit. The study also found that this prioritization approach may be applied regardless of the facility’s profit status, location, screening volume, practice type, and academic affiliation.
Offering immediate interpretation and diagnostic evaluation to women at high risk of a recall could greatly reduce the harms associated with false-positive screening mammograms, because the majority of harms are due women having to return for another visit, e.g., associated anxiety of waiting for a final result, opportunity costs, and financial costs. Women who haven’t had a mammogram in the prior 5 years may want to ask the facility if they could be scheduled for immediate interpretation of their screening mammogram to reduce their chances of having to return for a follow-up visit.
Ho TH, Bissell MCS, Lee CI, Lee JM, Sprague BL, Tosteson ANA, Wernli KJ, Henderson LM, Kerlikowske K, Miglioretti DL. Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation Based on Risk of Recall. J Am Coll Radiol. 2022 Oct 20:S1546-1440(22)00739-6. doi: 10.1016/j.jacr.2022.09.030. Epub ahead of print. PMID: 36273501. [Link]
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Posted by: Michael Bissell and Diana Miglioretti