Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the Million Women Study: cohort study

doi:10.1136/bmj.329.7464.477

BMJ 2004;329:477 (28 August), doi:10.1136/bmj.329.7464.477

Paper

Influence of personal characteristics of individual women on sensitivity and specificity of mammography in the Million Women Study: cohort study

Emily Banks, deputy director¹, Gillian Reeves, statistical epidemiologist¹, Valerie Beral, director¹, Diana Bull, senior statistician¹, Barbara Crossley, chief data manager¹, Moya Simmonds, clinical coordinator¹, Elizabeth Hilton, clinical coordinator¹, Stephen Bailey, clinical director², Nigel Barrett, clinical director³, Peter Briers, clinical director⁴, Ruth English, clinical director⁵, Alan Jackson, consultant radiologist⁶, Elizabeth Kutt, clinical director⁷, Janet Lavelle, clinical director⁸, Linda Rockall, clinical director⁹, Matthew G Wallis, clinical director¹⁰, Mary Wilson, clinical director¹¹, Julietta Patnick, national coordinator¹²

¹ Cancer Research UK Epidemiology Unit, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, ² Breast Screening Service, Princess of Wales Community Hospital, Bromsgrove B61 0BB, ³ West of London Breast Screening Service, Charing Cross Hospital, London W6 8RF, ⁴ Gloucestershire Breast Screening Service, Linton House, Cheltenham GL53 7AS, ⁵ Breast Care Unit, Oxford Radcliffe Hospital NHS Trust, Churchill Hospital, Oxford OX3 7JH, ⁶ Patricia Massey Breast Screening Unit, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, ⁷ Avon Breast Screening, Central Health Clinic, Tower Hill, Bristol BS2 0JD, ⁸ North Lancashire Breast Screening Service, Royal Lancaster Infirmary, Ashton Court, Lancaster LA1 4GG, ⁹ West Sussex Breast Screening Service, Worthing Hospital, Worthing BN11 2DH, ¹⁰ Breast Screening Unit, Coventry and Warwick Hospital, Coventry CV1 4FH, ¹¹ Greater Manchester Breast Screening Service, Nightingale Centre, Withington Hospital, Manchester M20 0PT, ¹² NHS Breast Screening Programme, Manor House, Sheffield S11 9PS

Correspondence to: E Banks emily.banks{at}anu.edu.au

Objectives To examine how lifestyle, hormonal, and other factorsinfluence the sensitivity and specificity of mammography.

Methods Women recruited into the Million Women Study completeda questionnaire about various personal factors before routinemammographic screening. A sample of 122 355 women aged 50-64years were followed for outcome of screening and incident breastcancer in the next 12 months. Sensitivity and specificity werecalculated by using standard definitions, with adjustment forpotential confounding factors.

Results Breast cancer was diagnosed in 726 (0.6%) women, 629in screen positive and 97 in screen negative women; 3885 (3.2%)were screen positive but had no subsequent diagnosis of breastcancer. Overall sensitivity was 86.6% and specificity was 96.8%.Three factors had an adverse effect on both measures: use ofhormone replacement therapy (sensitivity: 83.0% (95% confidenceinterval 77.4% to 87.6%), 84.7% (73.9% to 91.6%), and 92.1%(87.6% to 95.0%); specificity: 96.8% (96.6% to 97.0%), 97.8%(97.5% to 98.0%), and 98.1% (98.0% to 98.2%), respectively,for current, past, and never use); previous breast surgery vno previous breast surgery (sensitivity: 83.5% (75.7% to 89.1%)v 89.4% (86.5% to 91.8%); specificity: 96.2% (95.8% to 96.5%)v 97.4% (97.3% to 97.5%), respectively); and body mass index< 25 v $≥$ 25 (sensitivity: 85.7% (81.2% to 89.3%) v 91.0% (87.5%to 93.6%); specificity: 97.2% (97.0% to 97.3%) v 97.4% (97.3%to 97.6%), respectively). Neither sensitivity nor specificityvaried significantly according to age, family history of breastcancer, parity, past oral contraceptive use, tubal ligation,physical activity, smoking, or alcohol consumption.

Conclusions The efficiency, and possibly the effectiveness,of mammographic screening is lower in users of hormone replacementtherapy, in women with previous breast surgery, and in thinwomen compared with other women.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to Technorati Technorati What's this?

Breast screening works less well in some groups of women
BMJ 2004 329: 0. [Full Text]

This article has been cited by other articles:

Waller, M., Moss, S., Watson, J., Moller, H. (2007). The Effect of Mammographic Screening and Hormone Replacement Therapy Use on Breast Cancer Incidence in England and Wales. Cancer Epidemiol. Biomarkers Prev. 16: 2257-2261 [Abstract] [Full text]
Whitaker, C J, Kelly, C M, Faulkner, K, Stamp, E C (2006). Influence of menopausal status and use of hormone replacement therapy on radiation dose from mammography in routine breast screening.. Br. J. Radiol. 79: 597-602 [Abstract] [Full text]
Pisano, E. D., Gatsonis, C., Hendrick, E., Yaffe, M., Baum, J. K., Acharyya, S., Conant, E. F., Fajardo, L. L., Bassett, L., D'Orsi, C., Jong, R., Rebner, M., the Digital Mammographic Imaging Screening Trial (, (2005). Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening. NEJM 353: 1773-1783 [Abstract] [Full text]
Rutjes, A. W.S., Reitsma, J. B., Vandenbroucke, J. P., Glas, A. S., Bossuyt, P. M.M. (2005). Case-Control and Two-Gate Designs in Diagnostic Accuracy Studies. Clin. Chem. 51: 1335-1341 [Abstract] [Full text]
Fabian, C. J., Kimler, B. F., Mayo, M. S. (2004). Ductal Lavage for Early Detection--What Doesn't Come Out in the Wash. JNCI J Natl Cancer Inst 96: 1488-1489 [Full text]
(2004). What Factors Complicate Use of Screening Mammography?. JWatch General 2004: 2-2 [Full text]

Rapid Responses:

Read all Rapid Responses

A new way in breast cancer clinical primary prevention.: Sergio Stagnaro
bmj.com, 27 Aug 2004 [Full text]
alternatives: lee levine
bmj.com, 28 Aug 2004 [Full text]
Confounding factors in the Million Women Study?: Victor A. Palmer
bmj.com, 28 Aug 2004 [Full text]
The Million Women Study: what's in the name?: A Cecile JW Janssens, et al.
bmj.com, 28 Sep 2004 [Full text]