{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T04:30:12Z","timestamp":1794025812329,"version":"4.8.0"},"reference-count":22,"publisher":"Wiley","issue":"14","license":[{"start":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T00:00:00Z","timestamp":1588723200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01 HS018366\u201001A1"],"award-info":[{"award-number":["R01 HS018366\u201001A1"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","award":["PCS\u20101504\u201030370"],"award-info":[{"award-number":["PCS\u20101504\u201030370"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P01CA154292"],"award-info":[{"award-number":["P01CA154292"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U54CA163303"],"award-info":[{"award-number":["U54CA163303"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2020,7,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Established mammography screening performance metrics use the initial screening mammography assessment because they were developed for radiologist performance auditing, yet these metrics are frequently used to inform health policy and screening decision making. The authors have developed new performance metrics based on the final assessment that consider the entire screening episode, including diagnostic workup.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors used data from 2,512,577 screening episodes during 2005\u20102017 at 146 facilities in the United States participating in the Breast Cancer Surveillance Consortium. Screening performance metrics based on the final assessment of the screening episode were compared with conventional metrics defined with the initial assessment. Results were also stratified by breast density and breast cancer risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cancer detection rates were similar for the final assessment (4.1 per 1000; 95% confidence interval [CI], 3.8\u20104.3 per 1000) and the initial assessment (4.1 per 1000; 95% CI, 3.9\u20104.3 per 1000). The interval cancer rate was 12% higher when it was based on the final assessment (0.77 per 1000; 95% CI, 0.71\u20100.83 per 1000) versus the initial assessment (0.69 per 1000; 95% CI, 0.64\u20100.74 per 1000), and this resulted in a modest difference in sensitivity (84.1% [95% CI, 83.0%\u201085.1%] vs 85.7% [95% CI, 84.8%\u201086.6%], respectively). Absolute differences in the interval cancer rate between final and initial assessments increased with breast density and breast cancer risk (eg, a difference of 0.29 per 1000 for women with extremely dense breasts and a 5\u2010year risk &gt;2.49%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Established screening performance metrics underestimate the interval cancer rate of a mammography screening episode, particularly for women with dense breasts or an elevated breast cancer risk. Women, clinicians, policymakers, and researchers should use final\u2010assessment performance metrics to support informed screening decisions.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32939","type":"journal-article","created":{"date-parts":[[2020,5,6]],"date-time":"2020-05-06T11:05:53Z","timestamp":1588763153000},"page":"3289-3296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["New mammography screening performance metrics based on the entire screening episode"],"prefix":"10.1002","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7948-8317","authenticated-orcid":false,"given":"Brian L.","family":"Sprague","sequence":"first","affiliation":[{"name":"Department of Surgery University of Vermont Burlington Vermont USA"},{"name":"Department of Radiology University of Vermont Burlington Vermont USA"},{"name":"University of Vermont Cancer Center University of Vermont Burlington Vermont USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana L.","family":"Miglioretti","sequence":"additional","affiliation":[{"name":"Division of Biostatistics Department of Public Health Sciences University of California Davis School of Medicine Davis California USA"},{"name":"Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8185-7721","authenticated-orcid":false,"given":"Christoph I.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Washington School of Medicine Seattle Washington USA"},{"name":"Hutchinson Institute for Cancer Outcomes Research Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Radiology University of Vermont Burlington Vermont USA"},{"name":"University of Vermont Cancer Center University of Vermont Burlington Vermont USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna A. N.","family":"Tosteson","sequence":"additional","affiliation":[{"name":"Dartmouth Institute for Health Policy and Clinical Practice Lebanon New Hampshire USA"},{"name":"Norris Cotton Cancer Center Geisel School of Medicine at Dartmouth Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla","family":"Kerlikowske","sequence":"additional","affiliation":[{"name":"Department of Medicine University of California San Francisco San Francisco California USA"},{"name":"Department of Epidemiology and Biostatistics University of California San Francisco San Francisco California USA"},{"name":"General Internal Medicine Section Department of Veterans Affairs University of California San Francisco San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,6]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"ACR BI\u2010RADS\u00ae Atlas, Breast Imaging Reporting and Data System","author":"Sickles EA","year":"2013"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2016161174"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2886"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-0971"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-1465"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2017161519"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.14132806"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-1822"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.3040"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1789"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.169.4.9308451"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2222010647"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwk020"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/biostatistics\/kxg042"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.60.8869"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.1758"},{"key":"e_1_2_8_18_1","unstructured":"Are You Dense?State density reporting efforts\u2014because your life matters\u00ae. 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