Mammographic breast density: How it affects performance indicators in screening programmes?
Por:
Posso, M, Louro, J, Sanchez, M, Roman, M, Vidal, C, Sala, M, Bare, M, Castells, X, Buron, A, Domingo, L, Rodriguez-Arana, A, Servitja, S, Vernet, M, Benito, L, Quintana, MJ, Sola-Roca, J, Prieto, M, Galceran, J, Saladie, F, Ferrer, J, Espinas, JA, Penalva, L, Tora-Rocamora, I, Bargallo, X
Publicada:
1 ene 2019
Resumen:
Objectives: To investigate how breast density affects screening performance indicators in a digital mammography context.
Methods: We assessed the effect of breast density over the screen-detected and interval cancers rates, false-positives, specificity, sensitivity, recall rate, positive predictive value of recall (PPV-1), and PPV of invasive tests (PPV-2). Radiologists classified breast density using the BIRADS System. We used generalized estimating equations to account for within-woman correlation by means of the robust Huber-While variance estimator.
Results: We included 177,164 women aged 50-69 years who underwent 499,251 digital mammograms from 2004 to 2015 in Spain. According to the fibroglandular tissue percentage, 24.7% of mammograms were classified as BI-RADS 1 ( < 25% glandular), 54.7% as BI-RADS 2 (25-50% glandular), 14.0% as BI-RADS 3 (51-75% glandular) and 6.6% as BI-RADS 4 ( > 75% glandular). Overall, women with BI-RADS 3 had the highest screen-detected cancer rate (5.9 per 1000) and BI-RADS 4 the highest interval cancer rate (2.4 per 1000). Sensitivity decreased from 89.2% in women with BI-RADS 1 to 67.9% in BI-RADS 4. Both PPV-1 and PPV-2 decreased from 10.4% to 5.7% and from 49.8% to 32.4% in women with BI-RADS 1 and BI-RADS 4, respectively. Women aged 60-69 years with BI-RADS 4 had the lowest sensitivity (54.9%) and the highest interval cancer rate (3.8 per 1000).
Conclusions: Performance screening measures are negatively affected by breast density falling to a lower sensitivity and PPV, and higher interval cancer rate as breast density increases. Particularly women aged 60-69 years with > 75% glandular breasts had the worst results and therefore may be candidates for screening using other technologies.
Filiaciones:
Posso, M:
Res Network Hlth Serv Chron Dis REDISSEC, Barcelona, Spain
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
IMIM Hosp Mar Med Res Inst, Dept Epidemiol & Evaluat, Passeig Maritim 25-29, Barcelona 08003, Spain
Louro, J:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
Res Network Hlth Serv Chron Dis REDISSEC, Barcelona, Spain
UAB, Dept Pediat Obstet & Gynecol, Prevent Med & Publ Hlth,EHEA, Doctoral Programme Methodol Biomed Res & Publ Hlt, Barcelona, Spain
UAB, Methodol Biomed Res & Publ Hlth Program, Barcelona, Spain
IMIM Hosp Mar Med Res Inst, Dept Epidemiol & Evaluat, Passeig Maritim 25-29, Barcelona 08003, Spain
Sanchez, M:
Govt Cantabria, Gen Directorate Publ Hlth, Santander, Spain
Roman, M:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
Res Network Hlth Serv Chron Dis REDISSEC, Barcelona, Spain
IMIM Hosp Mar Med Res Inst, Dept Epidemiol & Evaluat, Passeig Maritim 25-29, Barcelona 08003, Spain
Vidal, C:
Catalan Inst Oncol, Canc Prevent & Monitoring Program, Barcelona, Spain
Sala, M:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
Res Network Hlth Serv Chron Dis REDISSEC, Barcelona, Spain
IMIM Hosp Mar Med Res Inst, Dept Epidemiol & Evaluat, Passeig Maritim 25-29, Barcelona 08003, Spain
Bare, M:
Parc Tauli Univ Hosp, Clin Epidemiol & Canc Screening, Sabadell, Spain
Res Network Hlth Serv Chron Dis REDISSEC, Barcelona, Spain
Parc Tauli Univ Hosp, Sabadell, Spain
Castells, X:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
IMIM Hosp Mar Med Res Inst, Dept Epidemiol & Evaluat, Passeig Maritim 25-29, Barcelona 08003, Spain
Res Network Hlth Serv Chron Dis REDISSEC, Barcelona, Spain
Buron, A:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
Domingo, L:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
Rodriguez-Arana, A:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
Servitja, S:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
Vernet, M:
IMIM Hosp Mar Med Res Inst, Barcelona, Spain
Benito, L:
Catalan Inst Oncol, Canc Prevent & Monitoring Program, Barcelona, Spain
Quintana, MJ:
Hosp Santa Creu & Sant Pau, Epidemiol Dept, Barcelona, Spain
Sola-Roca, J:
Hosp Santa Creu & Sant Pau, Epidemiol Dept, Barcelona, Spain
Prieto, M:
Principal Asturias Hlth Serv, Oviedo, Spain
Galceran, J:
Univ Rovira & Virgili, Fundacio Lliga Invest & Prevencio Canc, Tarragona, Spain
Saladie, F:
Univ Rovira & Virgili, Fundacio Lliga Invest & Prevencio Canc, Tarragona, Spain
Ferrer, J:
Hosp Santa Caterina, Girona, Spain
Espinas, JA:
Dept Hlth, Catalan Canc Plan, Barcelona, Spain
Penalva, L:
Private Fdn Asil Hosp, Granollers, Spain
Tora-Rocamora, I:
Prevent Med & Epidemiol Dept, Hosp Clin, Barcelona, Spain
Bargallo, X:
Prevent Med & Epidemiol Dept, Hosp Clin, Barcelona, Spain
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