Validation of a Medicare Claims-based Algorithm for Identifying Breast Cancers Detected at Screening Mammography

Background: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. Objectives:To validate a claims-based algorithm that can identify with high positive predictive value (PPV) incident breast cancers that were detected at screening mammography. Research Design: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). Subjects: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). Measures: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. Results: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%). Conclusions: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.

[1]  R. Hubbard,et al.  Distinguishing Screening From Diagnostic Mammograms Using Medicare Claims Data , 2014, Medical care.

[2]  C. Gross,et al.  The cost of breast cancer screening in the Medicare population. , 2013, JAMA internal medicine.

[3]  Karla Kerlikowske,et al.  Influence of annual interpretive volume on screening mammography performance in the United States. , 2011, Radiology.

[4]  D. Miglioretti,et al.  Identifying minimally acceptable interpretive performance criteria for screening mammography. , 2010, Radiology.

[5]  J. Elmore,et al.  Variability in interpretive performance at screening mammography and radiologists' characteristics associated with accuracy. , 2009, Radiology.

[6]  Karla Kerlikowske,et al.  Performance benchmarks for screening mammography. , 2006, Radiology.

[7]  Karla Kerlikowske,et al.  Can Medicare Billing Claims Data Be Used to Assess Mammography Utilization Among Women Ages 65 and Older? , 2006, Medical care.

[8]  Ruta Bajorunaite,et al.  An algorithm for the use of Medicare claims data to identify women with incident breast cancer. , 2006, Health services research.

[9]  S. Nass,et al.  Improving breast imaging quality standards , 2005 .

[10]  Jessica W T Leung,et al.  Performance benchmarks for diagnostic mammography. , 2005, Radiology.

[11]  S. Lemon,et al.  Classification and regression tree analysis in public health: Methodological review and comparison with logistic regression , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[12]  Karla Kerlikowske,et al.  Comparison of screening mammography in the United States and the United kingdom. , 2003, JAMA.

[13]  J. Goodwin,et al.  Using Medicare data to estimate the prevalence of breast cancer screening in older women: comparison of different methods to identify screening mammograms. , 2002, Health services research.

[14]  Deborah Schrag,et al.  Overview of the SEER-Medicare Data: Content, Research Applications, and Generalizability to the United States Elderly Population , 2002, Medical care.

[15]  Gregory S. Cooper,et al.  Studying Radiation Therapy Using SEER-Medicare-Linked Data , 2002, Medical care.

[16]  G. Cooper,et al.  Use of SEER-Medicare Data for Measuring Cancer Surgery , 2002, Medical care.

[17]  J. Goodwin,et al.  An approach to identifying incident breast cancer cases using Medicare claims data. , 2000, Journal of clinical epidemiology.

[18]  K. Kerlikowske,et al.  Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. , 1997, AJR. American journal of roentgenology.

[19]  E. Feuer,et al.  SEER Cancer Statistics Review, 1975-2003 , 2006 .