Use of clinical history affects accuracy of interpretive performance of screening mammography

Patricia A. Carney, Andrea J. Cook, Diana L. Miglioretti, Stephen A. Feig, Erin Aiello Bowles, Berta M. Geller, Karla Kerlikowske, Mark Kettler, Tracy Onega, Joann G. Elmore

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Objective: To examine how use of clinical history affects radiologist's interpretation of screening mammography. Study Design and Setting: Using a self-administered survey and actual interpretive performance, we examined associations between use of clinical history and sensitivity, false-positive rate, recall rate, and positive predictive value, after adjusting for relevant covariates using conditional logistic regression. Results: Of the 216 radiologists surveyed (63.4%), most radiologists reported usually or always using clinical history when interpreting screening mammography. Compared with radiologists who rarely use clinical history, radiologists who usually or always use it had a higher false-positive rate with younger women (10.7 vs. 9.7), denser breast tissue (10.1 for heterogeneously dense to 10.9 for extremely dense vs. 8.9 for fatty tissue), or longer screening intervals (> prior 5 years) (12.5 vs. 10.5). Effect of current hormone therapy (HT) use on false-positive rate was weaker among radiologists who use clinical history compared with those who did not (P = 0.01), resulting in fewer false-positive examinations and a nonsignificant lower sensitivity (79.2 vs. 85.2) among HT users. Conclusion: Interpretive performance appears to be influenced by patient age, breast density, screening interval, and HT use. This influence does not always result in improved interpretive performance.

Original languageEnglish (US)
Pages (from-to)219-230
Number of pages12
JournalJournal of Clinical Epidemiology
Issue number2
StatePublished - Feb 2012


  • Breast cancer risk
  • Interpretive acumen
  • Mammography

ASJC Scopus subject areas

  • Epidemiology


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