Improving Care Through Mammogram Quality Research

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Since October is Breast Cancer Awareness Month, I sat down with Brett Parkinson, MD, who is medical director of the Breast Care Center at Intermountain Medical Center and chairman of the Mammography Accreditation Program for the American College of Radiology, to talk about the latest in breast cancer research.

“One important area is called continuing outcomes research, where we retrospectively analyze how well we’re doing with our screening processes,” Dr. Parkinson said. “There are three metrics we look at: cancer detection rate, callback rate, and the rate of positive biospies.”

Cancer detection rate is a measure of how many cancers are detected per one thousand asymptomatic patients. An appropriate rate is between 2% and 8%. In a group of women who are screened every year it would be 2%, and in a never-screened population the rate would be 8%. Intermountain falls right in the sweet spot at 4% to 5% cancers detected on average.

Patient call back rate is a measure of how many women are called back as a result of finding something that needs to be investigated further. It may not be cancer, but it’s a finding that’s worth looking at a little closer. The ideal rate is 7% to 12%, with the national average at 10%. Intermountain falls right into that “normal” range for this metric, too.

As for the positive biopsy rate, it’s also a matter of getting the right frequency – striking a balance for the optimum level of utilization. A rate of 25% to 40% provides a good predictive value, and this is yet another benchmark that Intermountain Healthcare always meets.

How do we do so well?

“We are constantly providing feedback to our facilities across the system through an ongoing quality improvement project,” said Parkinson. “The feedback is blinded data, so our physicians only see what they’re doing, but can measure against everyone else, and by carefully analyzing their numbers, they can make adjustments to their practice and reduce the discrepancies. We started this in 2002 and we’ve found that we’ve been able to increase clinical effectiveness and reduce costs for the system and the patient without adversely affecting outcomes. In other words, we can reduce variability and still find the same number of cancers, in a way that works out better for everybody.”

Another recent quality study looked at a less invasive biopsy procedure – comparing the true-cut needle against the more invasive vacuum-assisted biopsy. Both of these are minimally invasive non-surgical procedures. The results? “By providing feedback to our clinicians,” Parkinson said, “we were able to reduce the utilization of the more costly, more invasive vacuum assisted biopsy.”

I asked Dr. Parkinson if there are any new research studies on the horizon.

“Yes! Right now we are looking at a new project for 2016, where we’ll be trying to reduce the false negative rate by analyzing all false negatives where cancer had developed within a year of a normal screening exam. This will help us understand why the results were negative, and how we can better catch these cancers earlier in the future.”

You can help support breast cancer research at Intermountain by supporting the Intermountain Research and Medical Foundation, where you can designate donations to go specifically to breast cancer research.

You can read Dr. Parkinson’s latest breast cancer article in Healthy Utah magazine here.