Based a new study published in the journal Radiology, the rate at which women are called back for supplementary imaging, following a screened mammography might be higher at hospitals than at community office clinics/practices, which is mostly credited to the differences among the patients. Researchers note that the data collected during the study offers insight into the limitations surrounding recall rates as a quality measure for breast cancer screening.
The Centers for Medicare & Medicaid Services selected the screening mammography recall rate as one of eight physician performance measures in 2006. In addition, the American College of Radiology (ACR) and the Agency for Healthcare Research and Quality recommend a target rate of less than 10 percent. 
Albeit the universal recall rate goals, the measure itself is strongly affected by patient factors, such as age, breast density, use of hormone replacement therapy, interval since the previous mammogram, and previous benign biopsy results.
Recall rates for mammography are reflected in the percentage of women who undergo screening and are called back for further testing. Since recalls involve anxiety for patients and additional costs, there have been efforts to keep these rates as low as possible.
"Recall rate by itself is used as a quality indicator by the federal government. Therefore, it remains important to understand the factors that influence recall rate for individuals and practices,” said Radiologist at the Rhode Island Hospital and the Alpert School of Medicine at Brown University in Providence, R.I., Ana Lourenco, M.D.
In an attempt to better understand such elements, Lourenco and the rest of the research team examined data between May 2008 and September 2011. Their point of focus was on five radiologists with breast imaging knowledge who read/interpreted mammograms at both academic medical centers and community practices.
The radiologists read/interpreted a sum of 74,297 screening mammograms (37,691 mammograms at the academic center and 36,606 at the community practice during the study period). The total recall of patients tallied to 5,799, for an overall recall rate of 7.8 percent. At 6.9 percent, the recall rate at the community site was significantly lower than the hospital rate of 8.6 percent.
"For every radiologist, the recall rate was significantly lower in community practice than in the hospital setting," said Lourenco.
Moreover, when researchers compared the two groups of patients, they found crucial differences which could have possibly affected recall rates. It was discovered that considerably more hospital patients had undergone previous surgeries and biopsies. A little more than 13 percent of the patients at the hospital location had medical backgrounds of surgery, as opposed to 5.6 percent at the community site, while 7 percent of hospital patients had undergone biopsies, compared with 1.4 percent at the community site.
"These patients may have more complicated mammograms to interpret or may be at higher risk for cancer than patients at the community site. Higher risk patients would be expected to increase the recall rate of the population,” said Lourenco.
One other major factor was patients’ ages. Average age of patients at the hospital was 56 years, compared to the average age of 63 years at the community site.
"Younger age has been associated with higher recall rates," added Lourenco.
For the time being, Lourenco credits all the effort put forth in developing quality metrics for breast cancer screening. However, she cautions that recall rates are influenced by elements beyond a radiologist's control; and therefore cannot be the sole determinant of the quality of a radiologist or an institution.
