Berta M. Geller

To examine whether mammographic assessments and recommendations are linked as expected, based on the Breast Imaging Reporting and Data System (BI-RADS), for the evaluation of women with signs and symptoms of breast disease. Eight mammography registries from the Breast Cancer Surveillance Consortium contributed mammographic data from 1996 through 1997 for women 25 years of age or older, with signs or symptoms of breast cancer. The association of assessments and recommendations and the relationship of self-reported symptoms to assessments are described. A total of 51,673 diagnostic mammograms were included in the analyses and the expected management recommendation was provided 85%-90% of the time for mammograms classified as assessment categories 1, 2, 4, or 5. Category 3 ("probably benign finding") had the most variability in associated management recommendations, with only 40% (2,998 of 7,423) of cases associated with the recommendation for short interval follow-up. Of the 1,648 category 0 mammograms ("needs additional imaging") that did not have a final assessment, 64% were recommended for additional imaging, while another 20% of the cases were recommended for either a consultation or biopsy. The number of women who reported a lump as a symptom decreased with age but was associated with higher BI-RADS assessments. BI-RADS assessment categories were generally used as intended for all categories but 0 and 3. Additional education about the use of these categories may be warranted. The inconsistencies between assessment category and management recommendations may present difficulties in conducting outcome audits.

Women at risk for inherited breast cancer have been identified for intervention studies through newly diagnosed relatives or from volunteers with a family history. This pilot study tested the use of a mammography registry to identify women at risk. Fifty women with first-degree relatives diagnosed as having breast cancer before age 45 were randomly selected from the Vermont Breast Cancer Surveillance System. Thirty-three women (66%) completed a phone interview that included a three-generation family pedigree of breast and ovarian cancers. Fifty-one percent of the women were at higher risk for inherited breast cancer based on the family history. Eighteen percent of the first-degree relatives' breast cancers were pathologically confirmed. Mammography registries that collect similar family history data may be used to identify women at risk for inherited breast cancer. Many intervention studies would require improved methods to obtain pathologic confirmation.