Performance of diagnostic mammography differs in the United States and Denmark

Allan Jensen, Berta M. Geller, Charlotte C. Gard, Diana L. Miglioretti, Bonnie Yankaskas, Patricia A. Carney, Robert D. Rosenberg, Ilse Vejborg, Elsebeth Lynge

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Diagnostic mammography is the primary imaging modality to diagnose breast cancer. However, few studies have evaluated variability in diagnostic mammography performance in communities, and none has done so between countries. We compared diagnostic mammography performance in community-based settings in the United States and Denmark. The performance of 93,585 diagnostic mammograms from 180 facilities contributing data to the US Breast Cancer Surveillance Consortium (BCSC) from 1999 to 2001 was compared to that of all 51,313 diagnostic mammograms performed at Danish clinics in 2000. We used the imaging workup's final assessment to determine sensitivity, specificity and an estimate of accuracy: area under the receiver-operating characteristics (ROCs) curve (AUC). Diagnostic mammography had slightly higher sensitivity in the United States (85%) than in Denmark (82%). In contrast, it had higher specificity in Denmark (99%) than in the United States (93%). The AUC was high in both countries: 0.91 in United States and 0.95 in Denmark. Denmark's higher accuracy may result from supplementary ultrasound examinations, which are provided to 74% of Danish women but only 37% to 52% of US women. In addition, Danish mammography facilities specialize in either diagnosis or screening, possibly leading to greater diagnostic mammography expertise in facilities dedicated to symptomatic patients. Performance of community-based diagnostic mammography settings varied markedly between the 2 countries, indicating that it can be further optimized.

Original languageEnglish (US)
Pages (from-to)1905-1912
Number of pages8
JournalInternational Journal of Cancer
Issue number8
StatePublished - Oct 15 2010


  • breast cancer
  • breast neoplasms
  • comparative health care
  • diagnostic mammography

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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