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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
×

ASSESSING AND IMPROVING THE

INTERPRETATION OF
BREAST IMAGES

WORKSHOP SUMMARY

Sharyl J. Nass and Margie Patlak, Rapporteurs

National Cancer Policy Forum

Board on Health Care Services

Institute of Medicine

image

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001

This project was supported by the American Cancer Society through a generous donation from the Longaberger Company’s Horizon of Hope Campaign®. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

International Standard Book Number-13: 978-0-309-37835-2
International Standard Book Number-10: 0-309-37835-4
DOI: 10.17226/21805

Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2015 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and improving the interpretation of breast images: Workshop Summary. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
×

WORKSHOP PLANNING COMMITTEE1

DIANA BUIST (Chair), Principal Investigator, Group Health Breast Cancer Surveillance

LORA BARKE, Radiologist, Radiology Imaging Associates, Invision Sally Jobe Breast Centers

PATRICIA A. CARNEY, Associate Director for Population Studies, Oregon Health & Sciences University Cancer Institute

PATRICIA GANZ, Distinguished Professor, Health Policy & Management and Medicine, University of California, Los Angeles (UCLA) Fielding School of Public Health, David Geffen School of Medicine at UCLA; Director, Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center

ABBE HERZIG, Patient Advocate

GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

DIANA MIGLIORETTI, Dean’s Professor in Biostatistics, Department of Public Health Sciences, University of California, Davis

BARBARA MONSEES, Evans Professor of Women’s Health, Emeritus Chief, Breast Imaging Section, Washington University School of Medicine

TRACY ONEGA, Professor, Section of Biostatistics & Epidemiology, Dartmouth Medical School

ETTA D. PISANO, Vice President for Medical Affairs, Dean, Medical University of South Carolina

Project Staff

SHARYL J. NASS, Director, National Cancer Policy Forum

PATRICK ROSS, Research Assistant

HANNAH DURING, Senior Program Assistant

_____________

1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
×

NATIONAL CANCER POLICY FORUM1

MICHAEL CALIGIURI (Chair), Chief Executive Officer, James Cancer Hospital and Solove Research Institute; Director, Ohio State University Comprehensive Cancer Center

PATRICIA A. GANZ (Vice Chair), Distinguished Professor, Health Policy & Management and Medicine, University of California, Los Angeles (UCLA) Fielding School of Public Health, David Geffen School of Medicine at UCLA; Director, Cancer Prevention and Control Research, UCLA Jonsson Comprehensive Cancer Center

AMY P. ABERNETHY, Chief Medical Officer and Senior Vice President for Oncology, Flatiron Health; Professor, Division of Medical Oncology, Duke University School of Medicine; Director, Center for Learning Health Care, Duke Clinical Research Institute

LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center

KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute

LOYCE PACE BASS, Health Policy Director, LIVESTRONG Foundation

MONICA BERTAGNOLLI, Professor of Surgery, Harvard University Medical School

OTIS BRAWLEY, Chief Medical Officer and Executive Vice President, American Cancer Society

CARLTON BROWN, Director of Professional Services, Oregon Nurses Association, and past president, Oncology Nursing Society

SERGIO CANTOREGGI, Chief Scientific Officer and Global Head of Research and Development, Helsinn Group

ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network

_____________

1 Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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GREGORY CURT, Executive Director for External Relations in US Medical Affairs, AstraZeneca; Co-Chair, Life Sciences Consortium Task Force

WILLIAM S. DALTON, Chief Executive Officer, M2Gen Personalized Medicine Institute, Moffitt Cancer Center; Chair, American Association for Cancer Research Science Policy & Legislative Affairs Committee

GWEN DARIEN, Executive Vice President, Programs and Services, Cancer Policy Institute, Cancer Support Community

WENDY DEMARK-WAHNEFRIED, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center

JAMES DOROSHOW, Director, Division of Cancer Treatment and Diagnosis, Deputy Director, Clinical and Translational Research, National Cancer Institute

CAROL A. HAHN, Associate Professor of Radiation Oncology, Duke University Medical Center; Medical Director of Radiation Oncology, Duke Raleigh Hospital; Clinical Affairs and Quality Council Chair, American Society for Radiation Oncology

LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor, Office of Nursing Services; Cancer Program Director, Albany Stratton Veterans Affairs Medical Center

SAMIR N. KHLEIF, Director, Georgia Health Sciences University Cancer Center, Georgia Regents University Cancer Center

LEE KRUG, Disease Area Head, Immuno-Oncology, Bristol-Myers Squibb

RICHARD A. LARSON, Hematology/Oncology Director, University of Chicago

MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine, Director, Comprehensive Cancer Center, University of Chicago

SHARI LING, Deputy Chief Medical Officer, Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services

GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

DANIEL R. MASYS, Affiliate Professor, Biomedical Informatics, University of Washington

MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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RICHARD PAZDUR, Director, Office of Oncology and Hematology Products, Food and Drug Administration

STEVEN PIANTADOSI, Phase One Foundation Endowed Chair and Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center

JENNIFER A. PIETENPOL, Director, Vanderbilt-Ingraham Cancer Center, Benjamin F. Byrd, Jr., Professor of Oncology, Professor of Biochemistry, Vanderbilt University

MACE L. ROTHENBERG, Chief Medical Officer & Senior Vice President, Clinical Development & Medical Affairs, Pfizer Oncology

AUGUST SALVADO, Senior Vice President, US Oncology Clinical Development & Medical Affairs, Novartis Oncology

ANDREW SCHIERMEIER, Senior Vice President, Head of Global Oncology, Merck Serono

RICHARD SCHILSKY, Chief Medical Officer, American Society of Clinical Oncology

DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School

YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center

ELLEN V. SIGAL, Chair and Founder, Friends of Cancer Research

RALPH WEICHSELBAUM, Daniel K. Ludwig Professor and Chair, Department of Radiation Oncology; Director, Ludwig Center for Metastasis Research, The University of Chicago Medical Center

GEORGE J. WEINER, Director, Holden Comprehensive Cancer Center, University of Iowa, President, Association of American Cancer Institutes

National Cancer Policy Forum Staff

SHARYL J. NASS, Forum Director and Director, Board on Health Care Services

PATRICK ROSS, Research Assistant

HANNAH DURING, Senior Program Assistant

PATRICK BURKE, Financial Associate

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
×

Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

Elena Elkin, Memorial Sloan Kettering Cancer Center

Louis Henderson, University of North Carolina

Ed Sickles, University of California, San Francisco

Dana Smetherman, Oschner Health Service

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this report was overseen by Sue Curry, University of Iowa. She was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Acknowledgments

We thank the American Cancer Society for sponsoring for this project through a generous donation from the Longaberger Company’s Horizon of Hope Campaign®.

Support from the many annual sponsors of the Institute of Medicine’s National Cancer Policy Forum is crucial to the work of the Forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Nonfederal sponsors include American Association for Cancer Research, American Cancer Society, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, EMD Serono, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, and the Oncology Nursing Society.

The Forum wishes to express its gratitude to the expert speakers whose presentations helped define the current challenges and opportunities for assessing and improving the quality of imaging interpretation in breast cancer screening and diagnosis. The Forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Acronyms

ACR

American College of Radiology

ACS

American Cancer Society

AHRQ

Agency for Healthcare Research and Quality

ARRT

American Registry of Radiologic Technologists

BCSC

Breast Cancer Surveillance Consortium

BI-RADS

Breast Imaging Reporting and Data System

CAD

computer-aided diagnosis

CME

Continuing Medical Education

CMS

Centers for Medicare & Medicaid Services

DCIS

ductal carcinoma in situ

FDA

Food and Drug Administration

FN

false negative

FP

false positive

HIPAA

Health Insurance Portability and Accountability Act of 1996

IOM

Institute of Medicine

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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MISA

Mammography Interpretive Skills Assessment

MOC

maintenance of certification

MQSA

Mammography Quality Standards Act

MRI

magnetic resonance imaging

NCI

National Cancer Institute

NMD

National Mammography Database

NMQAAC

National Mammography Quality Assurance Advisory Committee

PERFORMS

Personal Performance in Mammography Screening

PPV

positive predictive value

RT

Registered Technologist

RVU

relative value unit

TN

true negative

TP

true positive

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2015. Assessing and Improving the Interpretation of Breast Images: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21805.
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Millions of women undergo screening mammography regularly with the hope of detecting breast cancer at an earlier and more curable stage. But the ability of such screening to accurately detect early cancers depends on the quality of mammography, including high-quality image acquisition and interpretation. To help ensure the quality of mammography, Congress passed the Mammography Quality Standards Act (MQSA) in 1994 and last reauthorized it in 2004. In advance of its expected reauthorization in 2007, Congress requested a consensus study from the Institute of Medicine (IOM) recommending ways to improve the quality of mammography, with an emphasis on image interpretation. The resulting report, Improving Breast Imaging Quality Standards, highlighted the need to decrease variability in mammography interpretation in the United States and identified gaps in the evidence needed to develop best practices. The consensus committee found that mammography interpretation remained quite variable, and that this variability limited the full potential of mammography to reduce breast cancer mortality by detecting breast cancers at an early stage.

In May 2015, the IOM convened a workshop to address this issue. The participants discussed challenges in the delivery of high-quality mammography, the impact of training and experience on interpretive performance, how best to measure interpretive performance, and the potential impact of new technologies and supplemental imaging on interpretation of breast screening and diagnostic images. Assessing and Improving the Interpretation of Breast Images summarizes the presentations and discussions from this workshop.

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