Screening mammographic performance by race and age in the National Mammography Database: 29,479,665 screening mammograms from 13,181,241 women

PURPOSE

There are insufficient large-scale studies comparing the performance of screening mammography in women of different races. This study aims to compare the screening performance metrics across racial and age groups in the National Mammography Database (NMD).

METHODS

All screening mammograms performed between January 1, 2008, and December 31, 2021, in women aged 30-100 years from 746 mammography facilities in 46 U.S. states in the NMD were included. Patients were stratified by 10-year age intervals and 5 racial groups (African American, American Indian, Asian, White, unknown). Incidence of risk factors (breast density, personal history, family history of breast cancer, age), and time since prior exams were compared. Five screening mammography metrics were calculated: recall rate (RR), cancer detection rate (CDR), positive predictive values for recalls (PPV1), biopsy recommended (PPV2) and biopsy performed (PPV3).

RESULTS

29,479,655 screening mammograms performed in 13,181,241 women between January 1, 2008, and December 31, 2021, from the NMD were analyzed. The overall mean performance metrics were RR 10.00% (95% CI 9.99-10.02), CDR 4.18/1000 (4.16-4.21), PPV1 4.18% (4.16-4.20), PPV2 25.84% (25.72-25.97), PPV3 25.78% (25.66-25.91). With advancing age, RR significantly decreases, while CDR, PPV1, PPV2, and PPV3 significantly increase. Incidence of personal/family history of breast cancer, breast density, age, prior mammogram availability, and time since prior mammogram were mostly similar across all races. Compared to White women, African American women had significantly higher RR, but lower CDR, PPV1, PPV2 and PPV3.

CONCLUSIONS

Benefits of screening mammography increase with age, including for women age > 70 and across all races. Screening mammography is effective; with lower RR and higher CDR, PPV2, and PPV3 with advancing age. African American women have poorer outcomes from screening mammography (higher RR and lower CDR), compared to White and all women in the NMD. Racial disparity can be partly explained by higher rate of African American women lost to follow up.

Some cues are more equal than others: Cue plausibility for false alarms in baggage screening

This study investigated the effects of cue plausibility in a baggage screening task. 120 participants had to indicate whether a prohibited item was present in a series of grey-scaled X-ray images of baggage. They were assisted by a support system, which pointed at the location of a suspicious object. A 2 × 2 × 2 between-subjects design was used. Cue plausibility for false alarms (i.e. how the cued object was similar to a prohibited item) and support system reliability were manipulated at two levels (high/low). Furthermore, half of participants were provided with a rationale about automation failures (RAF) to reduce their negative impact on trust and performance. The results showed lower performance and more compliance with automation suggestions when cues were implausible than plausible. The RAF increased the response time and did not improve detection performance. Overall, this suggests that effective (computer-based) training is needed to reduce the negative effect of plausible cues.