Weiwei Zhu

OBJECTIVE. The purpose of this study was to determine whether digital breast tomosynthesis (DBT) adoption was associated with a decrease in screening mammography capacity across Breast Cancer Screening Consortium facilities, given concerns about increasing imaging and interpretation times associated with DBT. SUBJECTS AND METHODS. Facility characteristics and examination volume data were collected prospectively from Breast Cancer Screening Consortium facilities that adopted DBT between 2011 and 2014. Interrupted time series analyses using Poisson regression models in which facility was considered a random effect were used to evaluate differences between monthly screening volumes during the 12-month preadoption period and the 12-month postadoption period (with the two periods separated by a 3-month lag) and to test for changes in month-to-month facility-level screening volume during the preadoption and postadoption periods. RESULTS. Across five regional breast imaging registries, 15 of 83 facilities (18.1%...

Background: Medicare claims data may be a fruitful data source for research or quality measurement in mammography. However, it is uncertain whether claims data can accurately distinguish screening from diagnostic mammograms, particularly when claims are not linked with cancer registry data. Objectives: To validate claims-based algorithms that can identify screening mammograms with high positive predictive value (PPV) in claims data with and without cancer registry linkage. Research Design: Development of claims-derived algorithms using classification and regression tree analyses within a random half-sample of bilateral mammogram claims with validation in the remaining half-sample. Subjects: Female fee-for-service Medicare enrollees aged 66 years and older, who underwent bilateral mammography from 1999 to 2005 within Breast Cancer Surveillance Consortium (BCSC) registries in 4 states (CA, NC, NH, and VT), enabling linkage of claims and BCSC mammography data (N=383,730 mammograms obtained from 146,346 women). Measures: Sensitivity, specificity, and PPV of algorithmic designation of a “screening” purpose of the mammogram using a BCSC-derived reference standard. Results: In claims data without cancer registry linkage, a 3-step claims–derived algorithm identified screening mammograms with 97.1% sensitivity, 69.4% specificity, and a PPV of 94.9%. In claims that are linked to cancer registry data, a similar 3-step algorithm had higher sensitivity (99.7%), similar specificity (62.7%), and higher PPV (97.4%). Conclusions: Simple algorithms can identify Medicare claims for screening mammography with high predictive values in Medicare claims alone and in claims linked with cancer registry data.