Physician Predictors of Mammographic Accuracy

• Published in: JNCI : Journal of the National Cancer Institute 2005-03, Vol.97 (5), p.358-367
• Main Authors: Smith-Bindman, Rebecca, Chu, Philip, Miglioretti, Diana L., Quale, Chris, Rosenberg, Robert D., Cutter, Gary, Geller, Berta, Bacchetti, Peter, Sickles, Edward A., Kerlikowske, Karla
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Aged; Biological and medical sciences; Breast cancer; Breast Neoplasms - diagnostic imaging; Clinical Competence - standards; Colorado; Confidence Intervals; False Negative Reactions; False Positive Reactions; Female; Genital system. Mammary gland; Humans; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Male; Mammography; Mammography - standards; Mammography - statistics & numerical data; Medical sciences; Middle Aged; Multivariate Analysis; New Mexico; Odds Ratio; Physicians; Physicians - standards; Physicians - statistics & numerical data; Predictive Value of Tests; Radiodiagnosis. Nmr imagery. Nmr spectrometry; San Francisco; Sensitivity and Specificity; Tumors; Vermont
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/dji060

Background: The association between physician experience and the accuracy of screening mammography in community practice is not well studied. We identified characteristics of U.S. physicians associated with the accuracy of screening mammography. Methods: Data were obtained from the Breast Cancer Surveillance Consortium and the American Medical Association Master File. Unadjusted mammography sensitivity and specificity were calculated according to physician characteristics. We modeled mammography sensitivity and specificity by multivariable logistic regression as a function of patient and physician characteristics. All statistical tests were two-sided. Results: We studied 209 physicians who interpreted 1 220 046 screening mammograms from January 1, 1995, through December 31, 2000, of which 7143 (5.9 per 1000 mammograms) were associated with breast cancer within 12 months of screening. Each physician interpreted a mean of 6011 screening mammograms (95% confidence interval [CI] = 4998 to 6677), including a mean of 34 (95% CI = 28 to 40) from women diagnosed with breast cancer. The mean sensitivity was 77% (range = 29%–97%), and the mean false-positive rate was 10% (range = 1%–29%). After adjustment for the patient characteristics of those whose mammograms they interpreted, physician characteristics were strongly associated with specificity. Higher specificity was associated with at least 25 years (versus less than 10 years) since receipt of a medical degree (for physicians practicing for 25–29 years, odds ratio [OR] = 1.54, 95% CI = 1.14 to 2.08; P = .006), interpretation of 2500–4000 (versus 481–750) screening mammograms annually (OR = 1.30, 95% CI = 1.06 to 1.59; P = .011) and a high focus on screening mammography compared with diagnostic mammography (OR = 1.59, 95% CI = 1.37 to 1.82; P