New Hampshire Mammography Network Research Update, December 2004

The long-term objective of this Project is to improve the health of New Hampshire (NH) women by enhancing breast cancer screening and detection. To accomplish this, the New Hampshire Mammography Network (NHMN) has implemented a comprehensive database tracking system, allowing us to follow the outcomes of women receiving mammography (either diagnostic or screening) and other breast procedures (e.g. ultrasound, biopsy or fine needle aspiration) over time.

Past and Current Research Studies Related to NHMN

NHMN has successfully obtained peer-reviewed funding to conduct seven research projects, to date, including:

  1. 1996-1998 - A Breast Pathology Quality Improvement Project - State of N.H. Division of Public Health and the Centers for Disease Control - U57-CCU108362

  2. 1998-2002 - Assessing and Improving Interval Mammography Adherence - American Cancer Society - CRTG-98-280-01-CCE

  3. 1998-2000 - Anxiety, Risk and Breast Cancer Screening. NIH - Shannon Award -R55 NRO 4556-014) 2000-2003 - Understanding Variability in Community Mammography - Agency for Health Care Policy and Research - R01 HS10591-01

  4. 2000-2005 - Hormone Replacement therapy and Breast Cancer R01-CA080888-01A1

  5. 2000-2005 - Strategic Studies in Breast Cancer Detection and Surveillance -U01 CA86082-01

  6. 2004-2009 - Understanding Variability in Community Mammography, Phase II- AHRQ)

Research Findings

Thanks to the dedication and commitment of mammography centers throughout New Hampshire the NHMN has noted the following key research accomplishments:

Population-based Studies on Mammography

  • Screening mammography has a sensitivity of 72.4%, specificity of 97.3%, and positive predictive value (PPV) of 10.6%, which is lower than reported elsewhere.

  • Diagnostic mammography has higher sensitivity - 78.1%, lower specificity - 89.3%, and better PPV - 17.1%.

  • The cancer detection rate of screening is 3.3 per 1000 with a biopsy yield of 22%, while the interval cancer rate is 1.2 per 1000.

  • Nearly 80% of screen detected invasive malignancies are node negative. The recall rate for screening is 8.3%.

  • Ultrasonography is utilized in 3.5% of screening, and 17.5% of diagnostic encounters.

  • BI-RADS probably benign assessments are commonly misused.

  • Penetration of mammography relative to the NH population is higher for younger age groups (40-48% for those aged 44-64) than older age groups (34-39% for those aged 65-84).

  • The majority of mammographic encounters are routine screening exams (86%), often interpreted as negative or normal with benign findings (88%).

  • Use of comparison films to interpret either diagnostic or screening mammography occurs in 86% of encounters.

  • The distribution of pathology outcomes for diagnostic exams is very similar to that for screening exams (approximately 65% benign, 17% invasive breast cancer, and 6% non-invasive breast cancer).

  • Rate of cancer per 1000 examinations increases with age and is higher among women with a family history of breast cancer (3.2 for ages 30-39, 4.7 for ages 40-49, 6.6 for ages 50-59, 9.3 for ages 60-69) compared with those without (1.6 for ages 30-39, 2.7 for ages 40-49, 4.6 for ages 50-59, 6.9 for ages 60-69).

  • The sensitivity of mammography increases with age among women with a family history of breast cancer (63.2% for ages 30-39, 70.2% for ages 40-49, 81.3% for ages 50-59, 83.8% for ages 60-69) and those without (69.5% for ages 30-39, 77.5% for ages 40-49, 80.2% for ages 50-59, 87.7% for ages 60-69) but is similar for each decade of age irrespective of family history status.

Thank you to all technologists who have contributed to the study of women's breast health in New Hampshire. Your dedication is greatly appreciated!