Effects of digital mammography uptake on downstream breast-related care among older women.
Effects of digital mammography uptake on downstream breast-related care among older women.
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DOI：
10.1097/mlr.0b013e318269e9c2
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发表时间：
2012-12
期刊：
影响因子：
3
通讯作者：
Buist DS
中科院分区：
文献类型：
--
作者：
Hubbard RA;Zhu W;Onega TL;Fishman P;Henderson LM;Tosteson AN;Buist DS
数字化乳房X光检查是美国乳腺癌筛查的主要方式。此前还没有研究调查引入数字乳房X光检查对下游乳房相关护理的影响。比较引入数字乳房X光检查前后筛查乳房X光检查后与乳房相关的保健使用情况。对14家放射科机构筛查乳房X光照片的纵向研究，这些机构向乳腺癌监测联盟提供数据，在每个机构推出数字乳房X光检查前一年和之后四年进行，以及相关的医疗保险索赔。我们纳入了30,211名年龄在66岁及以上且未患乳腺癌的女性的乳房X光检查。基于放射科医生的评估和建议的假阳性召回率和短间隔随访率；基于医疗保险声明的随访率：乳房X光检查、超声波和乳房活检的使用率。在引入数字乳房X光摄影后，假阳性召回率增加。与前一年相比，在机构开始使用数字设备后的所有四年中，随访乳房X光检查的使用率显著高于前一年(第一年的优势比[OR]=1.7，95%可信区间[CI]：1.4，2.1)。在假阳性乳房X光检查结果的女性中，超声的使用在数字乳房X光检查开始后的第二到第四年显著减少(第二年OR=0.4，95%可信区间[CI]：0.3，0.6)。一项新技术的引入导致了医疗保健用途的变化，这种变化持续了至少四年。对新技术的比较有效性研究不仅应考虑诊断性能，还应考虑可归因于这一明显的学习曲线的下游利用。
Digital mammography is the dominant modality for breast cancer screening in the US. No previous studies have investigated how introducing digital mammography affects downstream breast-related care. Compare breast-related health care use following a screening mammogram before and after introduction of digital mammography. Longitudinal study of screening mammograms from 14 radiology facilities contributing data to the Breast Cancer Surveillance Consortium performed in the one year before and four years after each facility introduced digital mammography, along with linked Medicare claims. We included 30,211 mammograms for women age 66 years and older without breast cancer. Rates of false-positive recall and short-interval follow-up based on radiologists’ assessments and recommendations; rates of follow-up mammography, ultrasound, and breast biopsy use based on Medicare claims. False-positive recall rates increased following the introduction of digital mammography. Follow-up mammography use was significantly higher across all four years after a facility began using digital compared to the year before (year one odds ratio [OR] = 1.7, 95% confidence interval [CI]: 1.4, 2.1). Among women with false-positive mammography results, use of ultrasound decreased significantly in the second through fourth years after digital mammography began (year two OR = 0.4, 95% confidence interval [CI]: 0.3, 0.6). Introduction of a new technology led to changes in health care use that persisted for at least four years. Comparative effectiveness research on new technologies should consider not only diagnostic performance but also downstream utilization attributable to this apparent learning curve.