Department of Medicine, University of California San Francisco, San Francisco, CA 94110, USA.
Med Care. 2011 Jan;49(1):67-75. doi: 10.1097/MLR.0b013e3181f380e0.
Breast cancer missed on diagnostic mammography may contribute to delayed diagnoses, whereas false-positive results may lead to unnecessary invasive procedures. Whether accuracy of diagnostic mammography at facilities serving vulnerable women differs from other facilities is unknown.
To compare the interpretive performance of diagnostic mammography at facilities serving vulnerable women to those serving nonvulnerable women.
We examined 168,251 diagnostic mammograms performed at Breast Cancer Surveillance Consortium facilities from 1999 to 2005. We used hierarchical logistic regression to compare sensitivity, false positive rates, and cancer detection rates.
Women aged between 40 and 80 years underwent diagnostic mammography to evaluate an abnormal screening mammogram or breast problem.
Facilities were assigned vulnerability indices according to the populations served based on the proportion of mammograms performed on women with lower educational attainment, racial/ethnic minority status, limited household income, or rural residences.
Sensitivity of diagnostic mammography did not vary significantly across vulnerability indices adjusted for patient-level characteristics, but false-positive rates for diagnostic mammography examinations to evaluate a breast problem were higher at facilities serving vulnerable women defined as those with lower educational attainment (odds ratio [OR], 1.39; 95% confidence interval [CI]: 1.08, 1.79); racial/ethnic minorities (OR, 1.32; 95% CI: 0.98, 1.76); limited income (OR, 1.34; 95% CI: 1.08, 1.66); and rural residence (OR, 1.55; 95% CI: 1.27, 1.88).
Diagnostic mammography to evaluate a breast problem at facilities serving vulnerable women had higher false positive rates than at facilities serving nonvulnerable women. This may reflect concerns that vulnerable populations may be less likely to follow-up after abnormal diagnostic mammography or concerns that such populations have higher cancer prevalence.
在诊断性乳房 X 光检查中漏诊的乳腺癌可能导致诊断延迟，而假阳性结果可能导致不必要的侵入性操作。在为弱势群体服务的医疗机构和为非弱势群体服务的医疗机构中，诊断性乳房 X 光检查的准确性是否存在差异尚不清楚。
比较为弱势群体服务的医疗机构和为非弱势群体服务的医疗机构的诊断性乳房 X 光检查的解读性能。
我们检查了 1999 年至 2005 年期间在乳腺癌监测联盟机构进行的 168251 例诊断性乳房 X 光检查。我们使用分层逻辑回归比较了敏感性、假阳性率和癌症检出率。
年龄在 40 岁至 80 岁之间的女性接受诊断性乳房 X 光检查，以评估异常的筛查性乳房 X 光检查或乳房问题。
根据所服务人群的比例，根据接受教育程度较低、种族/少数民族、收入有限或居住在农村的女性进行乳房 X 光检查的比例，为机构分配脆弱性指数。
在调整了患者特征后，诊断性乳房 X 光检查的敏感性在脆弱性指数之间没有显著差异，但为评估乳房问题而进行的诊断性乳房 X 光检查的假阳性率在为弱势群体服务的机构中更高，弱势群体定义为受教育程度较低（优势比[OR]，1.39；95%置信区间[CI]：1.08，1.79）；少数民族（OR，1.32；95% CI：0.98，1.76）；收入有限（OR，1.34；95% CI：1.08，1.66）；和农村居民（OR，1.55；95% CI：1.27，1.88）。
为弱势群体服务的医疗机构中为评估乳房问题而进行的诊断性乳房 X 光检查的假阳性率高于为非弱势群体服务的医疗机构。这可能反映了弱势群体不太可能在异常诊断性乳房 X 光检查后进行随访的担忧，或者反映了此类人群癌症患病率较高的担忧。
