Dissemination of health technologies: Trends in the use of diagnostic test in breast cancer screening

J Healthc Qual Res. Jul-Aug 2019;34(4):177-184. doi: 10.1016/j.jhqr.2019.02.007. Epub 2019 Jun 28.


Objective: To analyse trends in the use of diagnostic test in breast cancer screening programs in Spain.

Materials and methods: Retrospective study of 542,695 women who had undergone at least one screening mammogram in any of the screening centres of three administrative regions in Spain, between 1996 and 2011. Process measures were: overall recall rate, overall invasive test rate, and rates of each type of invasive test (fine-needle aspiration biopsy, core-needle biopsy and surgical biopsy). As results measures were included detection of benign lesions rate, ductal in situ cancer rate and invasive cancer rate. Adjusted by age rates were estimated year by year for each measure and, also, the annual percent of change and its corresponding joint points.

Results: Core-needle biopsy rates decreased between 1996 and 1999 and changed trends in 1999-2011 with an increase of 4.9% per year. Overall recall rate declined by 4.6% from 1999 to 2004, invasive test rate declined between 1996 and 2004 by 24.3%. Fine-needle aspiration biopsy rate changes were: a 22.4% declined per year (1996-1998), and 13.5% declined per year (1998-2005). Benign lesions rate decreased from 1996 to 2011, 21.4% per year (1996-2001) and 6.0% (2001-2011). Ductal carcinoma in situ and invasive cancer had no-statistically significant changes.

Conclusion: The introduction of core-needle biopsy was slow and not concurrent with the reduction in the use of other diagnostic tests, but also represented a reduction in the rate of overall diagnostic tests and in the detection rate of benigns lesions without affecting the cancer detection rates.

Keywords: Biopsia con aguja gruesa; Breast cancer; Cancer screening; Cribado de cáncer de mama; Cáncer de mama; Diffusion of innovation; Difusión de la innovación; Evaluación de servicios sanitarios; Health services research; Health technology; Large-core needle biopsy; Tecnologías sanitarias.

Publication types

  • Multicenter Study

MeSH terms

  • Age Factors
  • Biomedical Technology / statistics & numerical data*
  • Biomedical Technology / trends
  • Biopsy / statistics & numerical data
  • Biopsy / trends
  • Biopsy, Fine-Needle / statistics & numerical data*
  • Biopsy, Fine-Needle / trends
  • Biopsy, Large-Core Needle / statistics & numerical data
  • Biopsy, Large-Core Needle / trends
  • Breast Diseases / diagnosis
  • Breast Diseases / epidemiology
  • Breast Diseases / pathology
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / pathology
  • Carcinoma, Intraductal, Noninfiltrating / diagnosis*
  • Carcinoma, Intraductal, Noninfiltrating / epidemiology
  • Carcinoma, Intraductal, Noninfiltrating / pathology
  • Diffusion of Innovation*
  • Female
  • Humans
  • Mass Screening / statistics & numerical data
  • Mass Screening / trends
  • Retreatment / statistics & numerical data*
  • Retrospective Studies
  • Spain / epidemiology
  • Time Factors