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

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 ScreeningDiagnostic Anxiety Inconvenience Resources Cost

8. Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety Inconvenience Resources Cost

9. Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety InconvenienceMore inconvenience Resources Cost

10. Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety InconvenienceMore inconvenience ResourcesMore resources Cost

11. Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety InconvenienceMore inconvenience ResourcesMore resources CostMore costs

12. Harms of Mammography ScreeningDiagnostic AnxietyMore anxiety InconvenienceMore inconvenience ResourcesMore resources CostMore 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

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

27. Radiology 2005; 235:775-790

28. 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

29. PPV 2 (Biopsy Recommended): 1996-2002 112,917 Exams 97,123 Exams 99,737 Exams 72,307 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

30. PPV 3 (Biopsy Performed): 1996-2002 112,917 Exams 97,123 Exams 99,737 Exams 72,307 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

31. 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

32. 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

33. 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

34. Percent Node Negative: 1996-2002 88,750 Exams 90,318 Exams 62,793 Exams 88,750 Exams105,378 Exams http://www.breastscreening.cancer.gov/data/benchmarks/diagnostic

35. 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

36. 5th Edition

37. 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

38. 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

39. 176,943 Exams 137,639 Exams 160,189 Exams 92,764 Exams Cancer Diagnosis Rate: 1996-2005