Rebecca Smith-Bindman

University of California, San Francisco, San Francisco, California, United States

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Publications (93)671.1 Total impact

  • Rebecca Smith-Bindman
    Journal of the American College of Radiology: JACR 07/2014; 11(7):746-7.
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    ABSTRACT: Urolithiasis (kidney stones) is a common reason for Emergency Department (ED) visits, accounting for nearly 1% of all visits in the United States. Computed Tomography (CT) has become the most common imaging test for these patients but there are few comparative effectiveness data to support its use in comparison to ultrasound. This paper describes the rationale and methods of STONE (Study of Tomography Of Nephrolithiasis Evaluation), a pragmatic randomized comparative effectiveness trial comparing different imaging strategies for patients with suspected urolithiasis. STONE is a multi-center, non-blinded pragmatic randomized comparative effectiveness trial of patients between age 18 and 75 with suspected nephrolithiasis seen in an ED setting. Patients were randomized to one of three initial imaging examinations: point-of-care ultrasound, ultrasound performed by a radiologist or CT. Participants then received diagnosis and treatment per usual care. The primary aim is to compare the rate of severe SAEs (Serious Adverse Events) between the three arms. In addition, a broad range of secondary outcomes was assessed at baseline and regularly for six months post-baseline using phone, email and mail questionnaires. Excluding 17 patients who withdrew after randomization, a total of 2759 patients were randomized and completed a baseline questionnaire (n=908, 893 and 958 in the Point-of-care Ultrasound, Radiology Ultrasound and Radiology CT arms, respectively). Follow-up is complete, and full or partial outcomes were assessed on over 90% of participants. The detailed methodology of STONE will provide a roadmap for comparative effectiveness studies of diagnostic imaging conducted in an ED setting.
    Contemporary clinical trials 04/2014; · 1.51 Impact Factor
  • Nicole Wilson, Victoria Valencia, Rebecca Smith-Bindman
    Journal of the American College of Radiology: JACR 03/2014; 11(3):231-2.
  • Rebecca Smith-Bindman, John M Boone
    Journal of the American College of Radiology: JACR 03/2014; 11(3):229-30.
  • Cindy S Lee, Erika Bildsten Reinhardt, Rebecca Smith-Bindman
    Journal of the American College of Radiology: JACR 03/2014; 11(3):255-6.
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    ABSTRACT: Purpose The National Quality Forum (NQF) is a nonprofit consensus organization that recently endorsed a measure focused on CT radiation doses. To comply, facilities must summarize the doses from consecutive scans within age and anatomic area strata and report the data in the medical record. Our purpose was to assess the time needed to assemble the data and to demonstrate how review of such data permits a facility to understand doses. Methods and Materials To assemble the data we used for analysis, we used the dose monitoring software eXposure to automatically export dose metrics from consecutive scans in 2010 and 2012. For a subset of 50 exams, we also collected dose metrics manually, copying data directly from the PACS into an excel spreadsheet. Results Manual data collection for 50 scans required 2 hours and 15 minutes. eXposure compiled the data in under an hour. All dose metrics demonstrated a 30% to 50% reduction between 2010 and 2012. There was also a significant decline and a reduction in the variability of the doses over time. Conclusion The NQF measure facilitates an institution's capacity to assess the doses they are using for CT as part of routine practice. The necessary data can be collected within a reasonable amount of time either with automatic software or manually. The collection and review of these data will allow facilities to compare their radiation dose distributions with national distributions and allow assessment of temporal trends in the doses they are using.
    Journal of the American College of Radiology: JACR 01/2014; 11(3):309–315.
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    ABSTRACT: Purpose The aim of this study was to determine whether providing radiologic technologists with audit feedback on doses from CT examinations they conduct and education on dose-reduction strategies reduces patients' radiation exposure. Methods This prospective, controlled pilot study was conducted within an integrated health care system from November 2010 to October 2011. Ten technologists at 2 facilities received personalized dose audit reports and education on dose-reduction strategies; 9 technologists at a control facility received no intervention. Radiation exposure was measured by the dose-length product (DLP) from CT scans performed before (n = 1,630) and after (n = 1,499) the intervention and compared using quantile regression. Technologists were surveyed before and after the intervention. Results For abdominal CT, DLPs decreased by 3% to 12% at intervention facilities but not at the control facility. For brain CT, DLPs significantly decreased by 7% to 12% at one intervention facility; did not change at the second intervention facility, which had the lowest preintervention DLPs; and increased at the control facility. Technologists were more likely to report always thinking about radiation exposure and associated cancer risk and optimizing settings to reduce exposure after the intervention. Conclusions Personalized audit feedback and education can change technologists' attitudes about, and awareness of, radiation and can lower patient radiation exposure from CT imaging.
    Journal of the American College of Radiology: JACR 01/2014; 11(3):300–308.
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    ABSTRACT: Background : Urolithiasis (kidney stones) is a common reason for Emergency Department (ED) visits, accounting for nearly 1% of all visits in the United States. Computed Tomography (CT) has become the most common imaging test for these patients but there are few comparative effectiveness data to support its use in comparison to ultrasound. This paper describes the rationale and methods of STONE (Study of Tomography Of Nephrolithiasis Evaluation), a pragmatic randomized comparative effectiveness trial comparing different imaging strategies for patients with suspected urolithiasis. Methods : STONE is a multi-center, non-blinded pragmatic randomized comparative effectiveness trial of patients between age 18 and 75 with suspected nephrolithiasis seen in an ED setting. Patients were randomized to one of three initial imaging examinations: point-of-care ultrasound, ultrasound performed by a radiologist or CT. Participants then received diagnosis and treatment per usual care. The primary aim is to compare the rate of severe SAEs (Serious Adverse Events) between the three arms. In addition, a broad range of secondary outcomes was assessed at baseline and regularly for six months post-baseline using phone, email and mail questionnaires. Results : Excluding 17 patients who withdrew after randomization, a total of 2759 patients were randomized and completed a baseline questionnaire (n = 908, 893 and 958 in the Point-of-care Ultrasound, Radiology Ultrasound and Radiology CT arms, respectively). Follow-up is complete, and full or partial outcomes were assessed on over 90% of participants. Conclusions : The detailed methodology of STONE will provide a roadmap for comparative effectiveness studies of diagnostic imaging conducted in an ED setting.
    Contemporary Clinical Trials. 01/2014;
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    ABSTRACT: IMPORTANCE There is wide variation in the management of thyroid nodules identified on ultrasound imaging. OBJECTIVE To quantify the risk of thyroid cancer associated with thyroid nodules based on ultrasound imaging characteristics. METHODS Retrospective case-control study of patients who underwent thyroid ultrasound imaging from January 1, 2000, through March 30, 2005. Thyroid cancers were identified through linkage with the California Cancer Registry. RESULTS A total of 8806 patients underwent 11 618 thyroid ultrasound examinations during the study period, including 105 subsequently diagnosed as having thyroid cancer. Thyroid nodules were common in patients diagnosed as having cancer (96.9%) and patients not diagnosed as having thyroid cancer (56.4%). Three ultrasound nodule characteristics-microcalcifications (odds ratio [OR], 8.1; 95% CI, 3.8-17.3), size greater than 2 cm (OR, 3.6; 95% CI, 1.7-7.6), and an entirely solid composition (OR, 4.0; 95% CI, 1.7-9.2)-were the only findings associated with the risk of thyroid cancer. If 1 characteristic is used as an indication for biopsy, most cases of thyroid cancer would be detected (sensitivity, 0.88; 95% CI, 0.80-0.94), with a high false-positive rate (0.44; 95% CI, 0.43-0.45) and a low positive likelihood ratio (2.0; 95% CI, 1.8-2.2), and 56 biopsies will be performed per cancer diagnosed. If 2 characteristics were required for biopsy, the sensitivity and false-positive rates would be lower (sensitivity, 0.52; 95% CI, 0.42-0.62; false-positive rate, 0.07; 95% CI, 0.07-0.08), the positive likelihood ratio would be higher (7.1; 95% CI, 6.2-8.2), and only 16 biopsies will be performed per cancer diagnosed. Compared with performing biopsy of all thyroid nodules larger than 5 mm, adoption of this more stringent rule requiring 2 abnormal nodule characteristics to prompt biopsy would reduce unnecessary biopsies by 90% while maintaining a low risk of cancer (5 per 1000 patients for whom biopsy is deferred). CONCLUSIONS AND RELEVANCE Thyroid ultrasound imaging could be used to identify patients who have a low risk of cancer for whom biopsy could be deferred. On the basis of these results, these findings should be validated in a large prospective cohort.
    JAMA Internal Medicine 08/2013; · 10.58 Impact Factor
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    ABSTRACT: The breast cancer detection rate is a benchmark measure of screening mammography quality, but its computation requires linkage of mammography interpretive performance information with cancer incidence data. A Medicare claims-based measure of detected breast cancers could simplify measurement of this benchmark and facilitate mammography quality assessment and research. To validate a claims-based algorithm that can identify with high positive predictive value (PPV) incident breast cancers that were detected at screening mammography. Development of a claims-derived algorithm using classification and regression tree analyses within a random half-sample of Medicare screening mammography claims followed by validation of the algorithm in the remaining half-sample using clinical data on mammography results and cancer incidence from the Breast Cancer Surveillance Consortium (BCSC). Female fee-for-service Medicare enrollees aged 68 years and older who underwent screening mammography from 2001 to 2005 within BCSC registries in 4 states (CA, NC, NH, and VT), enabling linkage of claims and BCSC mammography data (N=233,044 mammograms obtained by 104,997 women). Sensitivity, specificity, and PPV of algorithmic identification of incident breast cancers that were detected by radiologists relative to a reference standard based on BCSC mammography and cancer incidence data. An algorithm based on subsequent codes for breast cancer diagnoses and treatments and follow-up mammography identified incident screen-detected breast cancers with 92.9% sensitivity [95% confidence interval (CI), 91.0%-94.8%], 99.9% specificity (95% CI, 99.9%-99.9%), and a PPV of 88.0% (95% CI, 85.7%-90.4%). A simple claims-based algorithm can accurately identify incident breast cancers detected at screening mammography among Medicare enrollees. The algorithm may enable mammography quality assessment using Medicare claims alone.
    Medical care 08/2013; · 3.24 Impact Factor
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    ABSTRACT: IMPORTANCE Increased use of computed tomography (CT) in pediatrics raises concerns about cancer risk from exposure to ionizing radiation. OBJECTIVES To quantify trends in the use of CT in pediatrics and the associated radiation exposure and cancer risk. DESIGN Retrospective observational study. SETTING Seven US health care systems. PARTICIPANTS The use of CT was evaluated for children younger than 15 years of age from 1996 to 2010, including 4 857 736 child-years of observation. Radiation doses were calculated for 744 CT scans performed between 2001 and 2011. MAIN OUTCOMES AND MEASURES Rates of CT use, organ and effective doses, and projected lifetime attributable risks of cancer. RESULTS The use of CT doubled for children younger than 5 years of age and tripled for children 5 to 14 years of age between 1996 and 2005, remained stable between 2006 and 2007, and then began to decline. Effective doses varied from 0.03 to 69.2 mSv per scan. An effective dose of 20 mSv or higher was delivered by 14% to 25% of abdomen/pelvis scans, 6% to 14% of spine scans, and 3% to 8% of chest scans. Projected lifetime attributable risks of solid cancer were higher for younger patients and girls than for older patients and boys, and they were also higher for patients who underwent CT scans of the abdomen/pelvis or spine than for patients who underwent other types of CT scans. For girls, a radiation-induced solid cancer is projected to result from every 300 to 390 abdomen/pelvis scans, 330 to 480 chest scans, and 270 to 800 spine scans, depending on age. The risk of leukemia was highest from head scans for children younger than 5 years of age at a rate of 1.9 cases per 10 000 CT scans. Nationally, 4 million pediatric CT scans of the head, abdomen/pelvis, chest, or spine performed each year are projected to cause 4870 future cancers. Reducing the highest 25% of doses to the median might prevent 43% of these cancers. CONCLUSIONS AND RELEVANCE The increased use of CT in pediatrics, combined with the wide variability in radiation doses, has resulted in many children receiving a high-dose examination. Dose-reduction strategies targeted to the highest quartile of doses could dramatically reduce the number of radiation-induced cancers.
    JAMA pediatrics. 06/2013;
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    ABSTRACT: Objectives: Identifying the distributions and determinants of fluoroscopy time for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). Background: Invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) are significant contributors to radiation exposure from medical imaging in the US. Fluoroscopy time is a potentially-modifiable determinant of radiation exposure for these procedures, but has not been well characterized in contemporary practice. Methods: We evaluated the distribution of fluoroscopy time in patients undergoing ICA and/or PCI in the CathPCI Registry(®) , stratifying patients by numerous clinical scenarios. Hierarchical models were used to determine patient, procedure, operator and hospital-level factors associated with fluoroscopy time for these procedures. Results: Our study included a total of 3,295,348 ICA and PCI procedures performed by 9,600 operators from January 2005 through June 2009. There was wide variation in fluoroscopy times for these procedures with median [IQR] fluoroscopy times of 2.6 [1.7 - 4.5] minutes for ICA, 6.7 [4.2 - 10.8] minutes for ICA in patients with prior coronary artery bypass grafting (CABG), 10.1 [6.0 - 17.4] minutes for PCI, 10.7 [7.0 - 16.9] minutes for PCI with ICA, and 16.0 [10.6 - 24.0] minutes for PCI and ICA in patients with prior CABG. Prolonged fluoroscopy times (>30 minutes) were rare for ICA, but occurred in 6.7% of PCIs and 14.7% of PCIs in patients with prior CABG. After accounting for patient characteristics and procedure complexity, operator and hospital-level factors explained nearly 20% of the variation in fluoroscopy time. Conclusions: Fluoroscopy times vary widely during ICA and PCI with operator and hospital-level factors contributing substantially to these differences. A better understanding of potentially-modifiable sources of this variation will elucidate opportunities for enhancing the radiation safety of these procedures. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 05/2013; · 2.51 Impact Factor
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    ABSTRACT: 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.
    Medical care 08/2012; · 3.24 Impact Factor
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    ABSTRACT: Use of diagnostic imaging has increased significantly within fee-for-service models of care. Little is known about patterns of imaging among members of integrated health care systems. To estimate trends in imaging utilization and associated radiation exposure among members of integrated health care systems. Retrospective analysis of electronic records of members of 6 large integrated health systems from different regions of the United States. Review of medical records allowed direct estimation of radiation exposure from selected tests. Between 1 million and 2 million member-patients were included each year from 1996 to 2010. Advanced diagnostic imaging rates and cumulative annual radiation exposure from medical imaging. During the 15-year study period, enrollees underwent a total of 30.9 million imaging examinations (25.8 million person-years), reflecting 1.18 tests (95% CI, 1.17-1.19) per person per year, of which 35% were for advanced diagnostic imaging (computed tomography [CT], magnetic resonance imaging [MRI], nuclear medicine, and ultrasound). Use of advanced diagnostic imaging increased from 1996 to 2010; CT examinations increased from 52 per 1000 enrollees in 1996 to 149 per 1000 in 2010, 7.8% annual increase (95% CI, 5.8%-9.8%); MRI use increased from 17 to 65 per 1000 enrollees, 10% annual growth (95% CI, 3.3%-16.5%); and ultrasound rates increased from 134 to 230 per 1000 enrollees, 3.9% annual growth (95% CI, 3.0%-4.9%). Although nuclear medicine use decreased from 32 to 21 per 1000 enrollees, 3% annual decline (95% CI, 7.7% decline to 1.3% increase), PET imaging rates increased after 2004 from 0.24 to 3.6 per 1000 enrollees, 57% annual growth. Although imaging use increased within all health systems, the adoption of different modalities for anatomic area assessment varied. Increased use of CT between 1996 and 2010 resulted in increased radiation exposure for enrollees, with a doubling in the mean per capita effective dose (1.2 mSv vs 2.3 mSv) and the proportion of enrollees who received high (>20-50 mSv) exposure (1.2% vs 2.5%) and very high (>50 mSv) annual radiation exposure (0.6% vs 1.4%). By 2010, 6.8% of enrollees who underwent imaging received high annual radiation exposure (>20-50 mSv) and 3.9% received very high annual exposure (>50 mSv). Within integrated health care systems, there was a large increase in the rate of advanced diagnostic imaging and associated radiation exposure between 1996 and 2010.
    JAMA The Journal of the American Medical Association 06/2012; 307(22):2400-9. · 29.98 Impact Factor
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    ABSTRACT: While Medicare claims are a potential resource for clinical mammography research or quality monitoring, the validity of key data elements remains uncertain. Claims codes for digital mammography and computer-aided detection (CAD), for example, have not been validated against a credible external reference standard. We matched Medicare mammography claims for women who received bilateral mammograms from 2003 to 2006 to corresponding mammography data from the Breast Cancer Surveillance Consortium (BCSC) registries in four U.S. states (N = 253,727 mammograms received by 120,709 women). We assessed the accuracy of the claims-based classifications of bilateral mammograms as either digital versus film and CAD versus non-CAD relative to a reference standard derived from BCSC data. Claims data correctly classified the large majority of film and digital mammograms (97.2% and 97.3%, respectively), yielding excellent agreement beyond chance (κ = 0.90). Claims data correctly classified the large majority of CAD mammograms (96.6%) but a lower percentage of non-CAD mammograms (86.7%). Agreement beyond chance remained high for CAD classification (κ = 0.83). From 2003 to 2006, the predictive values of claims-based digital and CAD classifications increased as the sample prevalences of each technology increased. Medicare claims data can accurately distinguish film and digital bilateral mammograms and mammograms conducted with and without CAD. The validity of Medicare claims data regarding film versus digital mammography and CAD suggests that these data elements can be useful in research and quality improvement.
    Cancer Epidemiology Biomarkers &amp Prevention 06/2012; 21(8):1344-7. · 4.56 Impact Factor
  • Rebecca Smith-Bindman
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    ABSTRACT: Susan G. Komen for the Cure asked the Institute of Medicine (IOM) to perform a comprehensive review of environmental causes and risk factors for breast cancer. Interestingly, none of the consumer products (ie, bisphenol A, phthalates), industrial chemicals (ie, benzene, ethylene oxide), or pesticides (ie, DDT/DDE) considered could be conclusively linked to an increased risk of breast cancer, although the IOM acknowledged that the available evidence was insufficient to draw firm conclusions for many of these exposures, calling for more research in these areas. The IOM found sufficient evidence to conclude that the 2 environmental factors most strongly associated with breast cancer were exposure to ionizing radiation and to combined postmenopausal hormone therapy. The IOM's conclusion of a causal relation between radiation exposure and cancer is consistent with a large and varied literature showing that exposure to radiation in the same range as used for computed tomography will increase the risk of cancer. It is the responsibility of individual health care providers who order medical imaging to understand and weigh the risk of any medical procedures against the expected benefit.
    Archives of internal medicine 06/2012; 172(13):1023-7. · 11.46 Impact Factor
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    ABSTRACT: Purpose: To develop and demonstrate an automated computational method used to provide organ and effective dose assessments of computed tomography (CT) examinations, using a pre-calculated organ dose database. Methods: A five dimensional organ dose matrix, D (33 organs, 6 age groups, 2 genders, 3 tube potentials, scan positions with 1 cm z-resolution), was calculated using a Monte Carlo transport method which couples a reference CT scanner model (Siemens Sensation 16) with a series of pediatric and adult hybrid computational phantoms. CT scans with a given scan range were approximated as the sum of doses from multiple axial slices included in the scan range of interest. Patient-specific doses were calculated using the organ and effective doses normalized to CTDIvol of the reference scanner and patient/scan-specific parameters: body part scanned, CTDIvol, age, gender, scan length, kVp, and mAs. The parameters were obtained from a manually- and electronically-extracted DICOM dataset of 3,982 CT exams randomly selected from five health care systems participating in the NCI-funded Cancer Research Network (CRN). Illustrative dose analysis and comparison of dose for a subset of scans were performed. Results: Based on an evaluation of 3,983 CT examinations the following values were provided: effective dose, CTDIvol, dose length product (DLP) and the absorbed doses for 33 organs. Illustrative analysis for brain dose in head scans revealed a large dose variation in the age less than 30-year scans (COV=0.445) compared to the age above 30-year (COV=0.104). We observed that brain dose is strongly correlated with scan length compared to other scan parameters. Conclusion: The automated organ and effective dose calculation method developed in this study reduces the time needed to calculate doses on a large number of patients. We have successfully utilized this program for a variety of CT-related studies including retrospective epidemiological study and CT dose trend analysis studies.
    Medical Physics 06/2012; 39(6):3924-3925. · 2.91 Impact Factor
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    ABSTRACT: Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer. To conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline. MEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012). Of 591 citations identified and reviewed, 8 randomized trials and 13 cohort studies of LDCT screening met criteria for inclusion. Primary outcomes were lung cancer mortality and all-cause mortality, and secondary outcomes included nodule detection, invasive procedures, follow-up tests, and smoking cessation. Critical appraisal using predefined criteria was conducted on individual studies and the overall body of evidence. Differences in data extracted by reviewers were adjudicated by consensus. Three randomized studies provided evidence on the effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53,454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer−specific mortality, 274 vs 309 events per 100,000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95% CI, 0.73-0.93; absolute risk reduction, 0.33%; P = .004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer. There was marked heterogeneity in this finding and in the frequency of follow-up investigations, biopsies, and percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare. Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.
    JAMA The Journal of the American Medical Association 05/2012; 307(22):2418-29. · 29.98 Impact Factor
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    ABSTRACT: Facilities serving vulnerable women have higher false-positive rates for diagnostic mammography than facilities serving nonvulnerable women. False positives lead to anxiety, unnecessary biopsies, and higher costs. Examine whether availability of on-site breast ultrasound or biopsy services, academic medical center affiliation, or profit status explains differences in false-positive rates. We examined 78,733 diagnostic mammograms performed to evaluate breast problems at Breast Cancer Surveillance Consortium facilities from 1999 to 2005. We used logistic-normal mixed effects regression to determine if adjusting for facility characteristics accounts for observed differences in false-positive rates. Facilities were characterized as serving vulnerable women based on the proportion of mammograms performed on racial/ethnic minorities, women with lower educational attainment, limited household income, or rural residence. Although the availability of on-site ultrasound and biopsy services was associated with greater odds of a false positive in most models [odds ratios (OR) ranging from 1.24 to 1.88; P<0.05], adjustment for these services did not attenuate the association between vulnerability and false-positive rates. Estimated ORs for the effect of vulnerability indexes on false-positive rates unadjusted for facility services were: lower educational attainment [OR 1.33; 95% confidence intervals (CI), 1.03-1.74]; racial/ethnic minority status (OR 1.33; 95% CI, 0.98-1.80); rural residence (OR 1.56; 95% CI, 1.26-1.92); limited household income (OR 1.38; 95% CI, 1.10-1.73). After adjustment, estimates remained relatively unchanged. On-site diagnostic service availability may contribute to unnecessary biopsies, but does not explain the higher diagnostic mammography false-positive rates at facilities serving vulnerable women.
    Medical care 12/2011; 50(3):210-6. · 3.24 Impact Factor
  • Rebecca Smith-Bindman, Diana L Miglioretti
    Radiology 12/2011; 261(3):999; author reply 999-1000. · 6.34 Impact Factor

Publication Stats

3k Citations
671.10 Total Impact Points

Institutions

  • 1991–2014
    • University of California, San Francisco
      • • Department of Radiology and Biomedical Imaging
      • • Division of Hospital Medicine
      • • Veterans Affairs Medical Center
      • • Department of Epidemiology and Biostatistics
      San Francisco, California, United States
  • 2012
    • University of California, Davis
      • Department of Family and Community Medicine
      Davis, CA, United States
  • 2006–2012
    • National Institutes of Health
      • • Division of Cancer Epidemiology and Genetics
      • • Division of Cancer Prevention
      Bethesda, MD, United States
    • San Francisco VA Medical Center
      San Francisco, California, United States
    • Massachusetts General Hospital
      • Department of Radiology
      Boston, MA, United States
  • 2011
    • University of California, Berkeley
      • School of Public Health
      Berkeley, CA, United States
  • 2009
    • California Pacific Medical Center Research Institute
      San Francisco, California, United States
  • 2008
    • University of Illinois at Chicago
      Chicago, Illinois, United States
    • University of Auckland
      • Faculty of Medical and Health Sciences
      Auckland, Auckland, New Zealand
    • Santa Clara Valley Medical Center
      San Jose, California, United States
  • 2005–2008
    • CSU Mentor
      Long Beach, California, United States
  • 2007
    • Group Health Cooperative
      • Group Health Research Institute
      Seattle, Washington, United States
    • Oregon Health and Science University
      • Department of Family Medicine
      Portland, Oregon, United States
    • Moffitt Cancer Center
      • Department of Biostatistics
      Tampa, Florida, United States
  • 2004
    • UConn Health Center
      • Department of Genetics and Developmental Biology
      Farmington, CT, United States