Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice: A Multicenter Observational Study
Brian L Sprague, Emily F Conant, Tracy Onega, Michael P Garcia, Elisabeth F Beaber, Sally D Herschorn, Constance D Lehman, Anna N A Tosteson, Ronilda Lacson, Mitchell D Schnall, Despina Kontos, Jennifer S Haas, Donald L Weaver, William E Barlow, PROSPR Consortium, William Barlow, Mark Thornquist, Ziding Feng, Andrea Burnett-Hartman, John Inadomi, Constance Lehman, Chris Li, Constance Mao, Rachel Winer, Yingye Zheng, Stephanie Page-Lester, Suzanna Reid, Hallie Pritchett, Kiarra Witcher, Elisabeth Beaber, Michael Garcia, Dale McLerran, Janeira St. Clare, Deanna Stelling, Greg Warnick, Katrina Armstrong, Mitchell Schnall, Jinbo Chen, Emily Conant, Despina Kontos, Marilyn Schapira, Marie Synnestvedt, Mirar Bristol, Carrie Inge, Ahmed Ashraf, Nigel S Bristol, James Gee, Tory Harrington, Dan Heitjan, Steve Honeywell, Robert Hornik, Jordan Kahle, Brad Keller, Joseph Cappella, Andrew Maidment, Anne Marie McCarthy, Michael Meng-Kang Hsieh, Nandita Mitra, Andrew Oustimov, Lauren Pantalone, Holli Seitz, Shonket Ray, Christine Skubisz, Yuanjie Zheng, Brian L Sprague, Donald L Weaver, Berta M Geller, Oguzhan A Alagoz, Kim L Dittus, Kevin W Eliceiri, Mark F Evans, Andrew J Goodwin, Sally D Herschorn, Patricia J Keely, John A Shepherd, Joan M Skelly, Natasha K Stout, Amy Trentham-Dietz, Pamela M Vacek, Brenda L Waters, Mark Bowman, Kathleen Howe, Dawn Pelkey, Rachael Chicoine, Meghan Farrington, Cindy Groseclose, Victoria Hart, John Mace, Denis Nunez, Tiffany Pelkey, Dusty Quick, Oyewale Shiyanbola, Christopher Veal, Jennifer S Haas, Tracy Onega, Anna N A Tosteson, Robyn Birdwell, Ramin Khorasani, Ronilda Lacson, Elissa Ozanne, Tor D Tosteson, Asaf Bitton, Charles Brackett, Roberta di Florio, Joel Lazar, Wendy Wells, Mackenzie Bronson, Jane Chen, Martha Goodrich, Kimberly A Harris, Stella St. Hubert, Loretta Pearsonil, Steven Andrews, Kristen Anton, Katrine Batcho, Phyllis Brawarsky, Charles Cook, Amar Das, Ryan Dougher, Scottie Eliassen, Scott Farr, Carol Felone, Tracy Frazee, Scott Gerlach, George Getty, John Gilman, Dick Hanson, Dennis Johnson, Brenda Joseph, Leslie A Laam, Brian Levin, Meg Menkov, Steven Pyle, Laura Sims-Larabee, Ingrid Stendhal, Julie Weiss, Deborah Williams, David Bates, Graham Colditz, Harold Sox, Jessica Chubak, Aruna Kamineni, Diana S M Buist, Beverly B Green, Christopher L Owens, Carolyn M Rutter, Karen Wernli, Gabrielle Gundersen, Kristina Hansen, Vina Graham, Kevin P Filocamo, Ann Kelley, Kilian Kimbel, Steve Koets, Jennifer Macuiba, Melissa Rabelhofer, Renee Remedios, Leslie Sizemore, Hongyuan Gao, Scott Halgrim, Eric Johnson, Lawrence Madziwa, Malia Oliver, Chester Pabiniak, Diem-Thy Tran, Ethan A Halm, Celette Sugg Skinner, Jasmin A Tiro, Chul Ahn, Ruben Amarasingham, Bijal Balasubramanian, Stephen Inrig, Simon Craddock Lee, Milton Packer, Sandi Pruitt, Noel Santini, Isabel Scarinci, Amit Singa, Claudia Werner, Wendy Bishop, Katharine McCallister, Eric Borton, Adam Loewen, Joanne Sanders, Samir Gupta, Douglas A Corley, Chyke A Doubeni, Michael J Silverberg, Ann G Zauber, Theodore R Levin, Tina R Raine-Bennett, George F Sawaya, Christopher D Jensen, Natalia Udaltsova, Wei K Zhao, Chun R Chao, Virginia P Quinn, Alexander T Lee, Neal M Lonky, Joanne E Schottinger, Tracy A Becerra, Nirupa R Ghai, Richard Contreras, Angela Li, Cosette M Wheeler, Philip Castle, Jack Cuzick, Daniel Goldberg, Jane J Kim, Alan Waxman, Charles Wiggins, Lee Fernando, Ann Powell, Nicole G Campos, Eloisa Chavez, Jamilah Gamougoun, Verna Newman, Nikhil Patel, Jeannie Maurice, Scott Horlbeck, William C Hunt, Ruth McDonald, Orrin Myers, Michael Robertson, Stephen Sy, Robert Williams, Rachel Winer, Sarah Kobrin, V Paul Doria-Rose, Tonya Parker, Cheryl DeAguiar, Brian L Sprague, Emily F Conant, Tracy Onega, Michael P Garcia, Elisabeth F Beaber, Sally D Herschorn, Constance D Lehman, Anna N A Tosteson, Ronilda Lacson, Mitchell D Schnall, Despina Kontos, Jennifer S Haas, Donald L Weaver, William E Barlow, PROSPR Consortium, William Barlow, Mark Thornquist, Ziding Feng, Andrea Burnett-Hartman, John Inadomi, Constance Lehman, Chris Li, Constance Mao, Rachel Winer, Yingye Zheng, Stephanie Page-Lester, Suzanna Reid, Hallie Pritchett, Kiarra Witcher, Elisabeth Beaber, Michael Garcia, Dale McLerran, Janeira St. Clare, Deanna Stelling, Greg Warnick, Katrina Armstrong, Mitchell Schnall, Jinbo Chen, Emily Conant, Despina Kontos, Marilyn Schapira, Marie Synnestvedt, Mirar Bristol, Carrie Inge, Ahmed Ashraf, Nigel S Bristol, James Gee, Tory Harrington, Dan Heitjan, Steve Honeywell, Robert Hornik, Jordan Kahle, Brad Keller, Joseph Cappella, Andrew Maidment, Anne Marie McCarthy, Michael Meng-Kang Hsieh, Nandita Mitra, Andrew Oustimov, Lauren Pantalone, Holli Seitz, Shonket Ray, Christine Skubisz, Yuanjie Zheng, Brian L Sprague, Donald L Weaver, Berta M Geller, Oguzhan A Alagoz, Kim L Dittus, Kevin W Eliceiri, Mark F Evans, Andrew J Goodwin, Sally D Herschorn, Patricia J Keely, John A Shepherd, Joan M Skelly, Natasha K Stout, Amy Trentham-Dietz, Pamela M Vacek, Brenda L Waters, Mark Bowman, Kathleen Howe, Dawn Pelkey, Rachael Chicoine, Meghan Farrington, Cindy Groseclose, Victoria Hart, John Mace, Denis Nunez, Tiffany Pelkey, Dusty Quick, Oyewale Shiyanbola, Christopher Veal, Jennifer S Haas, Tracy Onega, Anna N A Tosteson, Robyn Birdwell, Ramin Khorasani, Ronilda Lacson, Elissa Ozanne, Tor D Tosteson, Asaf Bitton, Charles Brackett, Roberta di Florio, Joel Lazar, Wendy Wells, Mackenzie Bronson, Jane Chen, Martha Goodrich, Kimberly A Harris, Stella St. Hubert, Loretta Pearsonil, Steven Andrews, Kristen Anton, Katrine Batcho, Phyllis Brawarsky, Charles Cook, Amar Das, Ryan Dougher, Scottie Eliassen, Scott Farr, Carol Felone, Tracy Frazee, Scott Gerlach, George Getty, John Gilman, Dick Hanson, Dennis Johnson, Brenda Joseph, Leslie A Laam, Brian Levin, Meg Menkov, Steven Pyle, Laura Sims-Larabee, Ingrid Stendhal, Julie Weiss, Deborah Williams, David Bates, Graham Colditz, Harold Sox, Jessica Chubak, Aruna Kamineni, Diana S M Buist, Beverly B Green, Christopher L Owens, Carolyn M Rutter, Karen Wernli, Gabrielle Gundersen, Kristina Hansen, Vina Graham, Kevin P Filocamo, Ann Kelley, Kilian Kimbel, Steve Koets, Jennifer Macuiba, Melissa Rabelhofer, Renee Remedios, Leslie Sizemore, Hongyuan Gao, Scott Halgrim, Eric Johnson, Lawrence Madziwa, Malia Oliver, Chester Pabiniak, Diem-Thy Tran, Ethan A Halm, Celette Sugg Skinner, Jasmin A Tiro, Chul Ahn, Ruben Amarasingham, Bijal Balasubramanian, Stephen Inrig, Simon Craddock Lee, Milton Packer, Sandi Pruitt, Noel Santini, Isabel Scarinci, Amit Singa, Claudia Werner, Wendy Bishop, Katharine McCallister, Eric Borton, Adam Loewen, Joanne Sanders, Samir Gupta, Douglas A Corley, Chyke A Doubeni, Michael J Silverberg, Ann G Zauber, Theodore R Levin, Tina R Raine-Bennett, George F Sawaya, Christopher D Jensen, Natalia Udaltsova, Wei K Zhao, Chun R Chao, Virginia P Quinn, Alexander T Lee, Neal M Lonky, Joanne E Schottinger, Tracy A Becerra, Nirupa R Ghai, Richard Contreras, Angela Li, Cosette M Wheeler, Philip Castle, Jack Cuzick, Daniel Goldberg, Jane J Kim, Alan Waxman, Charles Wiggins, Lee Fernando, Ann Powell, Nicole G Campos, Eloisa Chavez, Jamilah Gamougoun, Verna Newman, Nikhil Patel, Jeannie Maurice, Scott Horlbeck, William C Hunt, Ruth McDonald, Orrin Myers, Michael Robertson, Stephen Sy, Robert Williams, Rachel Winer, Sarah Kobrin, V Paul Doria-Rose, Tonya Parker, Cheryl DeAguiar
Abstract
Background: About half of the United States has legislation requiring radiology facilities to disclose mammographic breast density information to women, often with language recommending discussion of supplemental screening options for women with dense breasts.
Objective: To examine variation in breast density assessment across radiologists in clinical practice.
Design: Cross-sectional and longitudinal analyses of prospectively collected observational data.
Setting: 30 radiology facilities within the 3 breast cancer screening research centers of the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium.
Participants: Radiologists who interpreted at least 500 screening mammograms during 2011 to 2013 (n = 83). Data on 216 783 screening mammograms from 145 123 women aged 40 to 89 years were included.
Measurements: Mammographic breast density, as clinically recorded using the 4 Breast Imaging Reporting and Data System categories (heterogeneously dense and extremely dense categories were considered "dense" for analyses), and patient age, race, and body mass index (BMI).
Results: Overall, 36.9% of mammograms were rated as showing dense breasts. Across radiologists, this percentage ranged from 6.3% to 84.5% (median, 38.7% [interquartile range, 28.9% to 50.9%]), with multivariable adjustment for patient characteristics having little effect (interquartile range, 29.9% to 50.8%). Examination of patient subgroups revealed that variation in density assessment across radiologists was pervasive in all but the most extreme patient age and BMI combinations. Among women with consecutive mammograms interpreted by different radiologists, 17.2% (5909 of 34 271) had discordant assessments of dense versus nondense status.
Limitation: Quantitative measures of mammographic breast density were not available for comparison.
Conclusion: There is wide variation in density assessment across radiologists that should be carefully considered by providers and policymakers when considering supplemental screening strategies. The likelihood of a woman being told she has dense breasts varies substantially according to which radiologist interprets her mammogram.
Primary funding source: National Institutes of Health.
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Source: PubMed