Strategies for Decreasing Screening Mammography Recall Rates While Maintaining Performance Metrics

From the 2018 HVPAA National Conference

Lisa Mullen (Johns Hopkins University), Susan Harvey (Johns Hopkins University), Babita Panigrahi (Johns Hopkins University), Eniola Falomo (Johns Hopkins University)

Background

Up to 10% of women are recalled from screening mammography for further evaluation, and the majority of recalls are ultimately benign. False positive screening recalls add significantly to health care costs and patient anxiety. Decreasing the screening recall rate would decrease cost, while maintaining patient safety and improving patient experience.

Objectives

This study aimed to determine the impact of interventions designed to reduce screening mammography recall rates on screening performance metrics.

Methods

We assessed baseline performance for full-field digital mammography (FFDM) and digital breast tomosynthesis mammography (DBT) for a 3-year period before intervention. The first intervention sought to increase awareness of recalls from screening mammography. Breast imagers discussed their perceptions regarding screening recalls and were required to review their own recalled cases, including outcomes of diagnostic evaluation and biopsy. The second intervention implemented consensus double reading of all recalls, requiring two radiologists to agree if recall was necessary. Recall rates, cancer detection rates, and positive predictive value 1 (PPV1) were compared before and after each intervention.

Results

The baseline recall rate, cancer detection rate, and PPV1 were 11.1%, 3.8/1000, and 3.4%, respectively, for FFDM, and 7.6%, 4.8/1000, and 6.0%, respectively, for DBT. Recall rates decreased significantly to 9.2% for FFDM and to 6.6% for DBT after the first intervention promoting awareness, as well as to 9.9% for FFDM after the second intervention implementing group consensus. PPV1 increased significantly to 5.7% for FFDM and to 9.0% for DBT after the second intervention. Cancer detection rate did not significantly change with the implementation of these interventions. An average of 2.3 minutes was spent consulting for each recall.

Conclusion

Our interventions decreased recall rates, while maintaining or improving performance metrics.

Implications for the Patient

Recall rate reduction, with maintenance or improvement of performance metrics, decreases health care costs while simultaneously improving patient safety and decreasing patient anxiety. These simple low cost interventions could be implemented in any breast imaging setting.

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