Department of Medicine, University of California San Francisco, San Francisco, CA 94110, USA.
Med Care. 2012 Mar;50(3):210-6. doi: 10.1097/MLR.0b013e3182407c8a.
Facilities serving vulnerable women have higher false-positive rates for diagnostic mammography than facilities serving nonvulnerable women. False positives lead to anxiety, unnecessary biopsies, and higher costs.
Examine whether availability of on-site breast ultrasound or biopsy services, academic medical center affiliation, or profit status explains differences in false-positive rates.
We examined 78,733 diagnostic mammograms performed to evaluate breast problems at Breast Cancer Surveillance Consortium facilities from 1999 to 2005. We used logistic-normal mixed effects regression to determine if adjusting for facility characteristics accounts for observed differences in false-positive rates.
Facilities were characterized as serving vulnerable women based on the proportion of mammograms performed on racial/ethnic minorities, women with lower educational attainment, limited household income, or rural residence.
Although the availability of on-site ultrasound and biopsy services was associated with greater odds of a false positive in most models [odds ratios (OR) ranging from 1.24 to 1.88; P<0.05], adjustment for these services did not attenuate the association between vulnerability and false-positive rates. Estimated ORs for the effect of vulnerability indexes on false-positive rates unadjusted for facility services were: lower educational attainment [OR 1.33; 95% confidence intervals (CI), 1.03-1.74]; racial/ethnic minority status (OR 1.33; 95% CI, 0.98-1.80); rural residence (OR 1.56; 95% CI, 1.26-1.92); limited household income (OR 1.38; 95% CI, 1.10-1.73). After adjustment, estimates remained relatively unchanged.
On-site diagnostic service availability may contribute to unnecessary biopsies, but does not explain the higher diagnostic mammography false-positive rates at facilities serving vulnerable women.
为弱势群体妇女提供服务的医疗机构进行诊断性乳房 X 光检查的假阳性率高于为非弱势群体妇女提供服务的医疗机构。假阳性会导致焦虑、不必要的活检和更高的成本。
检查现场乳房超声或活检服务的可用性、是否为学术医疗中心附属机构或盈利状况是否可以解释假阳性率的差异。
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 78733 次诊断性乳房 X 光检查，以评估乳房问题。我们使用逻辑正态混合效应回归来确定是否根据设施特征调整后可以解释假阳性率的差异。
根据种族/少数民族、教育程度较低、家庭收入有限或居住在农村的妇女进行乳房 X 光检查的比例，将医疗机构分为为弱势群体妇女提供服务的医疗机构。
尽管在大多数模型中，现场超声和活检服务的可用性与更高的假阳性几率相关（比值比 [OR] 范围从 1.24 到 1.88；P<0.05），但这些服务的调整并未减弱脆弱性与假阳性率之间的关联。未调整设施服务的脆弱性指标对假阳性率的影响的估计比值比为：教育程度较低[OR 1.33；95%置信区间（CI），1.03-1.74]；种族/少数民族（OR 1.33；95% CI，0.98-1.80）；农村居民（OR 1.56；95% CI，1.26-1.92）；家庭收入有限（OR 1.38；95% CI，1.10-1.73）。调整后，估计值相对不变。
现场诊断服务的可用性可能导致不必要的活检，但并不能解释为弱势群体妇女提供服务的医疗机构的诊断性乳房 X 光检查假阳性率较高。
