福井県におけるマンモグラフィ併用検診の問題点と精度向上への取り組み Problems That Have Arisen in Breast Cancer Screening with Mammography in Fukui Prefecture and a Trial to Improve Quality Control

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福井県では平成13年11月よりマンモグラフィ併用検診を開始し, 平成14年度のマンモグラフィ併用検診受診者総数2,314名, 発見乳癌数11例, 乳癌発見率0.48%と良好な成績であったが, 要精検率が16.1%と高率であり, 精度管理上の大きな問題点として指摘された。<BR>福井県のマンモグラフィ検診は検診バスによる分離併用A方式で, 読影は比較的経験の少ない第一読影医16名と, 経験豊富な第二読影医6名がダブルチェックし, 独立して判定しているが, 一人当たりの読影数が少ないこと, 第一読影医へのフィードバックがないこと, 症例検討や再読影システムがないことが原因として推測された。この対策として, (1) マンモグラム読影勉強会の開催, (2) 第一読影医へのフィードバックシステムの整備, (3) 読影医個人別の読影結果の通知公表などの取り組みを行い, 要精検率の低下を見た (16.1%から11.5%) 。これらの取り組みを組織的に継続施行することで, 診断精度の向上に努めたい。

Mammography was introduced for breast cancer screening in Fukui Prefecture in November, 2001. Breast cancer was detected by this method in 11 (0.48%) of 2, 314 women examined in 2002. The cancer detection rate was satisfactory, but the recall rate was as high as 16.1%. Therefore we recognized the need to decrease the recall rate by improving the quality control of mammography.<BR>We have adopted a separate A-type screening in which mammograms are obtained in a cancer screening car and the films are read twice by different doctors, the first reading being performed by 16 less-experienced doctors and the second reading by 6 experienced doctors, each independently. The high recall rate might have arisen for three reasons : (1) the number of mammograms read by one doctor was not enough to promote reading ability, (2) the first reader was not acquainted with the second reader's interpretation, and (3) there was no chance to discuss specific cases in detail, and there was no training course in mammogram reading.<BR>In order to solve these problems, (1) we set up a training course in mammogram reading, (2) devised a system for acquainting the first reader with the second reader's interpretation, and (3) made all the readers' interpretations available. As a result, the recall rate dropped to 11.5%. This has encouraged us to continue such trials to improve the quality control of mammography.

収録刊行物

  • 日本乳癌検診学会誌 = Journal of Japan Association of Breast Cancer Screening

    日本乳癌検診学会誌 = Journal of Japan Association of Breast Cancer Screening 13(1), 34-38, 2004-03-20

    Japan Association of Breast Cancer Screening

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各種コード

  • NII論文ID(NAID)
    10012864550
  • NII書誌ID(NCID)
    AN10398771
  • 本文言語コード
    JPN
  • 資料種別
    SHO
  • ISSN
    09180729
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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