{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:22:02Z","timestamp":1778826122745,"version":"3.51.4"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,6,24]],"date-time":"2019-06-24T00:00:00Z","timestamp":1561334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100000147","name":"Canadian Cancer Society","doi-asserted-by":"publisher","award":["316078"],"award-info":[{"award-number":["316078"]}],"id":[{"id":"10.13039\/501100000147","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The Ontario Breast Screening Program recommends annual mammography to women age 50\u201374 years at increased risk because of family history of breast or ovarian cancer or personal history of ovarian cancer or mammographic density 75% or greater. Few studies have examined the diagnostic accuracy of recommendations based on risk factors and included screen film as well as digital mammography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective design identified concurrent cohorts of women age 50\u201374 years screened annually or biennially with digital mammography only between 2011 and 2014 and followed until 2016 or breast cancer diagnosis. Diagnostic accuracy measures were compared between women screened annually because of first-degree relative of breast or ovarian cancer or personal history of ovarian cancer (n\u2009=\u200967\u2009795 women), mammographic density 75% or greater (n\u2009=\u200951\u2009956), or both (n\u2009=\u20093758) and those screened biennially (n\u2009=\u2009526\u2009815). The association between recommendation and sensitivity and specificity was assessed using generalized estimating equation models. All P values are two-sided.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For annual screening because of family or personal history vs biennial, sensitivity was statistically significantly higher (81.7% vs 70.6%; OR\u2009=\u20091.86, 95% CI = 1.48 to 2.34), particularly for invasive cancers and postmenopausal women. Although there was no statistically significant difference in sensitivity for annual screening for mammographic density 75% or greater, specificity was statistically significantly lower (91.3%; OR\u2009=\u20090.87, 95% CI = 0.80 to 0.96) vs biennial (92.3%), particularly for women age 50\u201359 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared with biennial screening, annual screening improved detection for women with a family or personal history of breast and\/or ovarian cancer, supporting screening that is more frequent. The benefit for annual screening for women with higher mammographic density must be weighed against possible harms of increased false positives.<\/jats:p><\/jats:sec>","DOI":"10.1093\/jnci\/djz131","type":"journal-article","created":{"date-parts":[[2019,6,20]],"date-time":"2019-06-20T21:15:02Z","timestamp":1561065302000},"page":"400-409","source":"Crossref","is-referenced-by-count":16,"title":["Annual vs Biennial Screening: Diagnostic Accuracy Among Concurrent Cohorts Within the Ontario Breast Screening Program"],"prefix":"10.1093","volume":"112","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7382-513X","authenticated-orcid":false,"given":"Anna M","family":"Chiarelli","sequence":"first","affiliation":[{"name":"Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina M","family":"Blackmore","sequence":"first","affiliation":[{"name":"Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Mirea","sequence":"first","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1770-988X","authenticated-orcid":false,"given":"Susan J","family":"Done","sequence":"first","affiliation":[{"name":"Laboratory Medicine Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicky","family":"Majpruz","sequence":"first","affiliation":[{"name":"Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashini","family":"Weerasinghe","sequence":"first","affiliation":[{"name":"Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Rabeneck","sequence":"first","affiliation":[{"name":"Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada"},{"name":"Phoenix Children\u2019s Hospital, Phoenix, AZ"},{"name":"Department of Medicine, University of Toronto, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Muradali","sequence":"first","affiliation":[{"name":"Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada"},{"name":"St. Michael\u2019s Hospital, Toronto, ON, Canada"},{"name":"Department of Medical Imaging, University of Toronto, Toronto, ON, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,6,24]]},"reference":[{"issue":"9","key":"2020041503553230100_djz131-B1","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1093\/jnci\/92.9.743","article-title":"Biologic characteristics of interval and screen-detected breast cancers","volume":"92","author":"Gilliland","year":"2000","journal-title":"J Natl Cancer Inst"},{"issue":"6","key":"2020041503553230100_djz131-B2","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/CEJ.0b013e328350b0f4","article-title":"Favourable prognostic factors of subsequent screen-detected breast cancers among women aged 50\u201369","volume":"21","author":"Chiarelli","year":"2012","journal-title":"Eur J Cancer Prev"},{"issue":"2","key":"2020041503553230100_djz131-B3","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1136\/jcp.53.2.140","article-title":"A study of interval breast cancer within the NHS breast screening programme","volume":"53","author":"Cowan","year":"2000","journal-title":"J Clin Pathol"},{"key":"2020041503553230100_djz131-B4","doi-asserted-by":"crossref","first-page":"E1441","DOI":"10.1503\/cmaj.180463","article-title":"Recommendations on screening for breast cancer in women aged 40-74 years who are not at increased risk for breast cancer","volume":"190","year":"2018","journal-title":"CMAJ"},{"issue":"4","key":"2020041503553230100_djz131-B5","doi-asserted-by":"crossref","first-page":"279","DOI":"10.7326\/M15-2886","article-title":"Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement","volume":"164","author":"Siu","year":"2016","journal-title":"Ann Intern Med"},{"issue":"4","key":"2020041503553230100_djz131-B6","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1093\/oxfordjournals.pubmed.a024793","article-title":"Do women who undergo further investigation for breast screening suffer adverse psychological consequences? 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