Usefulness of mammography in the diagnosis and management of breast disease in postmenopausal women.

We evaluated the clinical usefulness of mammography in postmenopausal women by conducting a "vertical" analysis using indexes of sensitivity and specificity, and a separate "horizontal" analysis assessing the relationship between the mammographic test result and the occurrence of specific clinical management decisions. The patients included 105 women with breast cancer, 104 women with fibrocystic breast disease, and 103 women with clinically benign breasts. Our study confirmed the generally accepted high values reported for the sensitivity and for the specificity of mammography as a test for breast cancer, while also helping to reconcile the widely varying indexes of test efficacy reported in some studies. We also observed that physicians' management decisions vary according to the mammographic interpretation, and include such distinctive clinical strategies as watchful expectancy (observe and follow), repeated mammograms, or breast biopsy. Future studies will need to determine reasons for specific management decisions, especially when they appear to contradict authoritative recommendations.