Prediction of Incomplete Screening Mammograms
Based on Age and Race
Tiffany D. Justice, MD, Jennifer H. Stiff, MD, John A. Myers, PhD, MSPH, and
Michael R. Milam, MD, MPH
Objective: This study examined the age-associated rate of incomplete mammograms requiring addi-
tional testing based on Breast Imaging–Reporting and Data System (BIRADS) score.
Methods: A retrospective, observational study design from a tertiary medical center was used to eval-
uate which explanatory variables significantly predicted whether a woman had an incomplete mammo-
gram. An incomplete mammogram was defined as a BIRADS score of 0 (requiring further imaging),
whereas a benign process was defined as a BIRADS score of 1 or 2. Explanatory variables included tra-
ditional clinical factors (age, race, and menopausal state).
Results: During the study period, 20,269 subjects were evaluated. The majority of the patients were
white (n ? 12,955; 64.6%) and had a BIRADS score consistent with a benign finding (n ? 17,571;
86.6%). Premenopausal state (odds ratio [OR], 1.38; 95% CI, 1.27–1.50), white race (OR, 1.18; 95% CI,
1.08–1.29), and younger age (OR, 1.38; 95% CI, 1.27–1.50) significantly increased the odds a woman
had an incomplete study.
Conclusions: In this cross-sectional, single-institution analysis, premenopausal state and white race
are associated with an increased rate for incomplete mammograms. Patients should be counseled ap-
propriately before the initiation of screening. (J Am Board Fam Med 2012;25:128–130.)
Keywords: BIRADS, Breast Cancer, Cancer Screening, Mammography
Breast cancer is the most frequently diagnosed can-
cer among women, accounting for 28% of the es-
timated new cases of cancer.1The recent US Pre-
ventive Services Task Force guidelines included
recommendations2of delaying the initiation of
screening mammography for average-rate women
until age 50 years, based in part on the risk of
false-positive findings and the need for additional
imaging.2This quickly elicited a response from
both the American Cancer Society and the Amer-
ican Congress of Obstetricians and Gynecologists
with their own reaffirmations to continue screening
women beginning at age 40 years.3
The disparities between the 3 groups prompted
an assessment of data from own our institution, a
tertiary care facility that provides both indigent and
referral care to women in the state of Kentucky.
We examined which explanatory variables pre-
dicted whether a woman had an incomplete screen-
ing mammogram, which requires additional testing
based on Breast Imaging–Reporting and Data Sys-
tem (BIRADS) score. A BIRADS score of 0 indi-
cates that a woman requires further imaging or
need for review of previous mammograms.4Iden-
tifying those women who may need further imag-
ing may help with counseling and scheduling
screening mammograms in certain patient popula-
A retrospective cross-sectional institutional review
board–approved study was performed on 20,283
consecutive subjects from the general gynecology
This article was externally peer reviewed.
Submitted 1 April, 2011; accepted 22 June, 2011.
From the Department of Obstetrics, Gynecology and
Women’s Health (TDJ, JHS, JAM, MRM); the Division of
Reproductive Endocrinology and Infertility (TDJ); the
School of Public Health and Information Sciences, Depart-
ment of Bioinformatics and Biostatistics (JAM); and the
Division of Gynecologic Oncology (MRM), University of
Conflict of interest: none declared.
Corresponding author: Tiffany D. Justice, Department of
Obstetrics, Gynecology & Women’s Health, University of
Louisville School of Medicine, 550 South Jackson St, Lou-
isville, KY 40202 (E-mail: email@example.com).
January–February 2012Vol. 25 No. 1http://www.jabfm.org