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Yeong SW, Lee SW, Ong SC. Cost-Effectiveness of Breast Cancer Early Detection Program in Low- and Middle-Income Countries: A Systematic Review. Value Health Reg Issues 2023; 35:57-68. [PMID: 36870173 DOI: 10.1016/j.vhri.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/19/2022] [Accepted: 01/20/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES This review explores the cost-effectiveness of the strategies used in the breast cancer early detection programs of low- to middle-income countries. METHODS A systematic review was performed to identify related studies, published up to August 2021, on PubMed, Cochrane, ProQuest, and the Cumulative Index to Nursing and Allied Health Literature. The Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol were referenced during the reporting process. The Consolidated Health Economic Evaluation Reporting Standards 2022 criteria were used to assess the requirements of the selected studies. Articles with original data and full texts were included in the review. Non-low- to middle-income countries and non-English articles were excluded. RESULTS This review identified 12 suitable studies, wherein 6 investigated the cost-effectiveness of clinical breast examinations (CBEs), whereas 10 looked into mammogram (MMG) with or without CBE. In 2 studies, the cost-effectiveness of raising awareness through mass media and the use of ultrasounds combined with CBE were investigated. Although cost-effective, MMG incurs greater costs and requires more skill to be performed. MMG screenings before the age of 40 years were not cost-effective. The limitations of this review include variability in the methodological approaches of its selected studies. Most of the chosen studies met the Consolidated Health Economic Evaluation Reporting Standards 2022 criteria. CONCLUSIONS This review shows that adopting an age- and risk-based MMG screening approach could be viable in countries with limited resources. Future cost-effectiveness analysis research should include a section on patient and stakeholder engagement with the study's results.
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Affiliation(s)
- Siew Wei Yeong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Sit Wai Lee
- Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
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Zanetti R, Ponti A, Rosso S, Ricceri F, Pitarella S, Segnan N. The Beginning of a Decline in Breast Cancer Incidence in Italy? TUMORI JOURNAL 2018; 94:293-6. [DOI: 10.1177/030089160809400301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of invasive breast cancer in Turin, Italy, showed a statistically significant decrease during 1999–2003 overall (estimated annual percent change -2.6; 95% CL -8.52; -0.78) and in women aged over 50, similar to the recently documented trend in American data. This represents the first demonstration of a decline in breast cancer incidence in the early years of this decade outside the United States. In our population, the drop in the usage of hormone replacement therapy which occurred after 2002 is unlikely to be at the origin of this declining incidence trend, which is largely explained by a screening effect. This observation may be relevant to other geographical areas where organized or spontaneous screening reached a plateau after an increase in the preceding years.
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Affiliation(s)
| | - Antonio Ponti
- Unità di Valutazione dello Screening Mammografico, CPO, Turin, Italy
| | | | | | - Sabina Pitarella
- Unità di Valutazione dello Screening Mammografico, CPO, Turin, Italy
| | - Nereo Segnan
- Unità di Epidemiologia dei Tumori, Centro per l'Epidemiologia e la Prevenzione Oncologica, CPO, Turin, Italy
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Rossi PG, Camilloni L, Mantellini P, Barile V, Borgia P, Federici A, Mangia M, Paci E, Vella A, Zappa M. Breast Cancer Diagnostic Methods: Screen-Detected and Clinical Cases. An Italian Survey of Women's Experiences. TUMORI JOURNAL 2018; 93:452-60. [DOI: 10.1177/030089160709300508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background The real practice of breast cancer diagnosis and treatment is often very different from guideline recommendations. Screening programs should minimize deviations from “best practice”. The aim of the study was to compare cases detected by screening programs with cases that were not part of the public screening program, analyzing the diagnostic pathways from the first suspected breast problem to therapeutic intervention for breast cancer. Methods We interviewed a random sample of 268 women aged 49–70 years in three Italian regions (Lazio, Tuscany, Basilicata) who were treated for breast cancer, stratified by screening participation. Results In the nonscreened group, 48% of women were symptomatic and 50% were diagnosed by preventive tests. The proportion of women treated within 30 days of diagnosis was significantly lower in the screened group, 21.3% vs 35.8% (P = 0.0003). The mean number of tests (mammography, ultrasonography, cytology and histology) performed in the screened group was significantly higher than in the nonscreened group, 3.7 vs 2.8 (P = 0.001). The percentage of women treated without a preoperative histological or cytological diagnosis was lower in the screened group than in the nonscreened group, 14% vs 25% (P = 0.024). Conclusion Participation in screening programs seems to lead to more appropriate disease management even for breast cancer cases treated at the same hospital.
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Affiliation(s)
| | | | | | | | | | - Antonio Federici
- Center for Disease Control and Prevention (CCM), Ministry of Health, Rome
| | | | - Eugenio Paci
- Centro per lo Studio e la Prevenzione Oncologica, Florence
| | | | - Marco Zappa
- Centro per lo Studio e la Prevenzione Oncologica, Florence
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Bucchi L, Falcini F, Baraldi GP, Bondi A, Bonsanto R, Bravetti P, Desiderio F, de Bianchi PS. Integrating Self-Referral for Mammography into Organised Screening: Results from an Italian Experience. J Med Screen 2016; 10:134-8. [PMID: 14561265 DOI: 10.1177/096914130301000307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare self-referred screenees with respondents to invitation for main performance indicators of mammography screening. SETTING First round of an organised, population-based screening programme in six districts of northern Italy. METHODS The screening test was a two-view mammography. Eligible women aged 50-69 years were invited. Self-referred attendees were accepted if they were eligible for screening and had not yet been invited or had been invited >6 months before presentation. Age-specific performance indicators were compared with the calculation of their ratio and 95% confidence intervals (CIs). Total ratios were age standardised. In situ carcinomas were excluded. RESULTS The eligible population was 183 542 women. There were 112 188 respondents to invitation and 20 280 self-referred attendees. Self-referral rate was inversely related to age. Performance indicators were as follows: recall rate, 5.6% for self-referred attendees vs 5.5% for respondents (ratio 1.02, 95% CI 0.96 to 1.08); total aspiration cytology rate, 37.3% vs 28.3% (1.37, 1.24 to 1.51); biopsy rate, 17.0 vs 12.6 x 1000 (1.51, 1.35 to 1.67); total detection rate, 10.7 vs 7.5 x 1000 (1.70, 1.48 to 1.94); detection rate of pT1 carcinoma, 7.0 vs 6.1 x 1000 (1.35, 1.14 to 1.59); detection rate of pT2-4 carcinoma, 3.5 vs 1.2 x 1000 (3.51, 2.75 to 4.43); false-positive rate, 4.5% vs 4.7% (0.93, 0.87 to 0.99); positive predictive value (PPV) of mammography, 19.1% vs 13.5% (1.59, 1.39 to 1.82); PPV of biopsy, 63.7% vs 60.6% (1.13, 0.98 to 1.29); detected:expected ratio, 5.02 vs 3.37 (1.49, 1.28 to 1.74). All differences were more pronounced among or restricted to women aged 50-54 years. CONCLUSIONS Self-referred screenees were similar to respondents to invitation in main indicators of screening feasibility such as recall rate and PPV of biopsy, while showing important increases in detection rates and detected:expected ratios, especially among women aged 50-54 years.
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Affiliation(s)
- L Bucchi
- Romagna Cancer Registry, Medical Oncology Department, Luigi Pierantoni Hospital, 47100 Forl , Italy.
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Zorzi M, Guzzinati S, Puliti D, Paci E. A simple method to estimate the episode and programme sensitivity of breast cancer screening programmes. J Med Screen 2011; 17:132-8. [PMID: 20956723 DOI: 10.1258/jms.2010.009060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The estimation of breast cancer screening sensitivity is a major aim in the quality assessment of screening programmes. The proportional incidence method for the estimation of the sensitivity of breast cancer screening programmes is rarely used to estimate the underlying incidence rates. METHODS We present a method to estimate episode and programme sensitivity of screening programmes, based solely on cancers detected within screening cycles (excluding breast cancer cases at prevalent screening round) and on the number of incident cases in the total target population (steady state). The assumptions, strengths and limitations of the method are discussed. An example of calculation of episode and programme sensitivities is given, on the basis of the data from the IMPACT study, a large observational study of breast cancer screening programmes in Italy. RESULTS The programme sensitivity from the fifth year of screening onwards ranged between 41% and 48% of the total number of cases in the target population. At steady state episode sensitivity was 0.70, with a trend across age groups, with lowest values in women aged 50-54 years (0.52) and highest in those 65-69 (0.77). CONCLUSIONS The method is a very serviceable tool for estimating sensitivity in service screening programmes, and the results are comparable with those of other methods of estimation.
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Affiliation(s)
- Manuel Zorzi
- Venetian Tumour Registry, Istituto Oncologico Veneto - IOV IRCCS, Passaggio Gaudenzio, 1, 35131 Padua, Italy.
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Up-to-date estimates of breast cancer survival for the years 2000–2004 in 11 European countries: The role of screening and a comparison with data from the United States. Eur J Cancer 2010; 46:3351-7. [DOI: 10.1016/j.ejca.2010.09.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/07/2010] [Accepted: 09/08/2010] [Indexed: 11/18/2022]
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Ponti A, Rosso S, Zanetti R, Ricceri F, Tomatis M, Segnan N. Re: Breast Cancer Incidence, 1980-2006: Combined Roles of Menopausal Hormone Therapy, Screening Mammography, and Estrogen Receptor Status. J Natl Cancer Inst 2007; 99:1817-8; author reply 1819. [DOI: 10.1093/jnci/djm225] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Cabeza E, Esteva M, Pujol A, Thomas V, Sánchez-Contador C. Social disparities in breast and cervical cancer preventive practices. Eur J Cancer Prev 2007; 16:372-9. [PMID: 17554211 DOI: 10.1097/01.cej.0000236243.55866.b0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Knowledge of factors related to the use of preventive practices is essential in order to build strategies to decrease cancer incidence and mortality. The aim of this study is to describe the characteristics of women who periodically use cervical smear and mammography. This is a cross-sectional study based on the 2001 Balearic Health Survey, using a stratified sample of non-institutionalized population resident in the Balearic Islands. The study included 560 women, aged 20 years or over. The variables studied were age, marital status, social class, education, place of residence and birth, self-perceived health status, satisfaction with health services, job status and type of medical coverage. A multivariate analysis was performed using logistic regression models. Thirty-five per cent had regular mammography (72% between 50 and 64 years) and 54% had cervical smears. The probability of having undergone mammography is higher in women between the ages of 50 and 64 years [odds ratio (OR)=11.74; interval confidence (IC): 5.89-23.39] and in those with additional medical coverage (OR=1.97; IC: 1.19-3.27) and much lower in single women (OR=0.22; IC: 0.10-0.49). The probability of having undergone a Pap test increases according to educational level (OR=2.25; IC: 0.98-5.18 for women in the higher level) and social class (OR=1.98; IC: 0.91-4.28 for social class I) and decreases in women older than 65 years (OR=0.15; IC: 0.07-0.35) and in single women (OR=0.29; IC: 0.16-0.50). Age and marital status are factors related to both practices. Socio-economic status remains associated with cervical smear use, while having an additional medical coverage increases the probability of regular mammography.
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Affiliation(s)
- Elena Cabeza
- Department of Public Health, Balearic Department of Health and Consumer Affairs, Palma de Mallorca, Spain.
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von Euler-Chelpin M, Olsen AH, Njor S, Vejborg I, Schwartz W, Lynge E. Women's patterns of participation in mammography screening in Denmark. Eur J Epidemiol 2007; 21:203-9. [PMID: 16547835 DOI: 10.1007/s10654-006-0002-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2006] [Indexed: 11/27/2022]
Abstract
The objective of the study is to analyse individual women's participation patterns in mammography screening in Denmark. The study is set in the capital of Copenhagen and the county of Fyn representing around 95,000 women aged 50-69. The Central Population Register (CPR) was used to define the total target group, and supply information on migrations and deaths. Invitation and participation data came from the mammography screening programmes in Copenhagen (1991-1999) and Fyn (1993-2001), containing personal identification number, data on invitation date, participation and examination date for each screening round. In Copenhagen the coverage went from 70.5% in the first round to 63.1% in the fourth round, and the equivalent data for Fyn is 84.6% in the first round and 82.8% in the fourth round. Of the women eligible for at least three invitation rounds, 52.6% in Copenhagen and 76.4% in Fyn were faithful users, i.e. had participated in all screenings they were invited to. The conclusion is that the programme participation rates tend to overestimate the protection of the individual women covered by the programme. Behind the urban-rural gradient in programme participation is an even greater gradient in programme protection.
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Affiliation(s)
- My von Euler-Chelpin
- Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5 opg. B, Postboks 2099, 1014, København K, Denmark.
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Zorzi M, Puliti D, Vettorazzi M, De Lisi V, Falcini F, Federico M, Ferretti S, Moffa IF, Mangone L, Mano MP, Naldoni C, Ponti A, Traina A, Tumino R, Paci E. Mastectomy rates are decreasing in the era of service screening: a population-based study in Italy (1997-2001). Br J Cancer 2006; 95:1265-8. [PMID: 17043685 PMCID: PMC2360582 DOI: 10.1038/sj.bjc.6603405] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We enrolled all 2162 in situ and 21 148 invasive cases of breast cancer in 17 areas of Italy, diagnosed in 1997–2001. Rates of early cancer increased by 13.7% in the screening age group (50–69 years), and breast conserving surgery by 24.6%. Advanced cancer rates decreased by 19.4%, and mastectomy rates by 24.2%. Service screening did not increase mastectomy rates in the study population.
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Affiliation(s)
- M Zorzi
- Istituto Oncologico Veneto, Padova, Italy
| | - D Puliti
- Clinical and Descriptive Epidemiology Unit-CSPO-Research Institute of the Tuscany Region, Firenze, Italy
| | | | | | - F Falcini
- Romagna Cancer Registry, Forlì, Italy
| | | | | | - I F Moffa
- Epidemiology Unit-ASL 2, Perugia, Italy
| | - L Mangone
- Reggio-Emilia Cancer Registry, Reggio-Emilia, Italy
| | - M P Mano
- University of Turin-Department of Biological Sciences and Human Oncology, Turin, Italy
| | - C Naldoni
- Screening program-Emilia-Romagna Region Health Department, Bologna, Italy
| | - A Ponti
- Epidemiology Unit-CPO Piemonte, Turin, Italy
| | - A Traina
- Department of Oncology-ARNAS Ascoli, Palermo, Italy
| | - R Tumino
- Cancer Registry and Human Pathology Department-Arezzo Hospital, Ragusa, Italy
| | - E Paci
- Clinical and Descriptive Epidemiology Unit-CSPO-Research Institute of the Tuscany Region, Firenze, Italy
- E-mail:
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Paci E, Ponti A, Zappa M, Patriarca S, Falini P, Delmastro G, Bianchi S, Sapino A, Vezzosi V, Senore C, Crocetti E, Frigerio A, Zanetti R, Del Turco MR, Segnan N. Early diagnosis, not differential treatment, explains better survival in service screening. Eur J Cancer 2005; 41:2728-34. [PMID: 16239106 DOI: 10.1016/j.ejca.2005.06.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Revised: 06/16/2005] [Accepted: 06/17/2005] [Indexed: 10/25/2022]
Abstract
Italian population-based breast cancer screening programmes with 2-year, high-quality mammography started in the cities of Florence and Turin in the early 1990s. Breast cancer cases from the local Tumour Registry were classified by method of detection and tumour characteristics (size, nodal-status and grade). Follow-up was at December 2001. In total, 4444 breast cancer cases were analysed. The Hazard Ratio comparing before and after-invitation breast cancer cases indicated a 27% reduction (HR=0.73; 95%CI: 0.61-0.87) in the risk of dying for the disease. After adjustment for tumour characteristics, survival rate was comparable by invitation status, whereas the proportion of early cancer was 33.7% and 46.6% in the before and after-invitation group. Survival rates by tumour characteristic subgroups was comparable by invitation status. Late stage and grade 3 were indicators of poor prognosis. Adjustment for tumour characteristics confirmed screening and not differential treatment as the most important reason for the observed survival benefit. The survival analysis by specific subgroups did not support the hypothesis that the difference in prognosis was attributable to differential treatment.
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Affiliation(s)
- Eugenio Paci
- Unit of Clinical and Descriptive Epidemiology, Centre for Study and Prevention of Cancer, Research Institute of Tuscany Region, Via di San Salvi 12, 50125 Firenze, Florence, Italy.
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Lynge E, Olsen AH, Fracheboud J, Patnick J. Reporting of performance indicators of mammography screening in Europe. Eur J Cancer Prev 2003; 12:213-22. [PMID: 12771560 DOI: 10.1097/00008469-200306000-00008] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We compared short-term indicators for service mammography screening in Europe. Data were available from 17 programmes, although not all programmes provided a comprehensive reporting. More than 90% of the target population had been screened within the last 3 years in the WE trial, whereas only two-thirds of women in England and Copenhagen had been screened within the last 3 years, which will delay or reduce the effect of screening compared with the trial. Participation was highest in sparsely populated areas. Detection rates at first screen reached three times the baseline in Copenhagen, the Netherlands and North-West England. The clinical characteristics of screen-detected cases were badly reported. Given their importance for the long-term effect of screening, further data are warranted. Sensitivity and specificity could be measured only indirectly; they showed, however, considerable variation between programmes. Fyn, Florence and Stockholm had succeeded in combining high specificity with high sensitivity. With different recall policies, different proportions of women will experience a false-positive test; expected numbers after three screens were 14%, 10% and 1%, for England, Copenhagen and the Netherlands, respectively. Based on the observed wide variation in short-term indicators, a similar wide variation is expected in the effect of screening on breast cancer mortality.
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Affiliation(s)
- E Lynge
- Institute of Public Health, University of Copenhagen, Blegdamsvej 3, DK 2200 København N, Denmark.
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Yankaskas BC, Cleveland RJ, Schell MJ, Kozar R. Association of recall rates with sensitivity and positive predictive values of screening mammography. AJR Am J Roentgenol 2001; 177:543-9. [PMID: 11517044 DOI: 10.2214/ajr.177.3.1770543] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The performance of screening mammography is measured mainly by its sensitivity, positive predictive value, and cancer detection rate. Recall rates are also suggested as a surrogate measure. The main objective of this study was to measure the effect on sensitivity and positive predictive value as recall rates increase in the community practice of mammography. MATERIALS AND METHODS Mammography and pathology data are linked in the Carolina Mammography Registry, a population-based registry of screening mammography. Our mammography database is created from prospectively collected data from mammography facilities; the data include information on the woman and the imaging studies. Our pathology database is created from prospectively collected breast pathology data received from pathology sites and the Central Cancer Registry. Women in the registry who were 40 years old and older and who underwent screening mammography between January 1994 and June 1998 were included. "Recall rate" was defined as the percentage of screening studies for which further workup was recommended by the radiologist. RESULTS The study included 215,665 screening mammograms. The mean age of the women was 56 years. The recall rates of the average practice ranged from 1.9% to 13.4%. Sensitivity rose from a mean of 65% in the lowest recall rates to 80.2% at the highest level of recall rates. The positive predictive value of screening decreased from 7.2% in the lowest level of recall to 3.3% in the highest. As recall rates increased, sensitivity increased very little beyond a recall rate of 4.8%, and positive predictive value began decreasing significantly at a recall rate of 5.9%. CONCLUSION Practices with recall rates between 4.9% and 5.5% achieve the best trade-off of sensitivity and positive predictive value.
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Affiliation(s)
- B C Yankaskas
- Department of Radiology, CB 7515, Mason Farm Rd., University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7515, USA
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