{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:50:53Z","timestamp":1787021453207,"version":"build-2736575974"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1099","license":[{"start":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T00:00:00Z","timestamp":1559692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>After a 500 ms presentation, experts can distinguish abnormal mammograms at above chance levels even when only the breast contralateral to the lesion is shown. Here, we show that this signal of abnormality is detectable 3 years before localized signs of cancer become visible.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In 4 prospective studies, 59 expert observers from 3 groups viewed 116\u2013200 bilateral mammograms for 500 ms each. Half of the images were prior exams acquired 3 years prior to onset of visible, actionable cancer and half were normal. Exp. 1D included cases having visible abnormalities. Observers rated likelihood of abnormality on a 0\u2013100 scale and categorized breast density. Performance was measured using receiver operating characteristic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In all three groups, observers could detect abnormal images at above chance levels 3 years prior to visible signs of breast cancer (p &amp;lt; 0.001). The results were not due to specific salient cases nor to breast density. Performance was correlated with expertise quantified by the number of mammographic cases read within a year. In Exp. 1D, with cases having visible actionable pathology included, the full group of readers failed to reliably detect abnormal priors; with the exception of a subgroup of the six most experienced observers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Imaging specialists can detect signals of abnormality in mammograms acquired years before lesions become visible. Detection may depend on expertise acquired by reading large numbers of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge:<\/jats:title>\n                    <jats:p>Global gist signal can serve as imaging risk factor with the potential to identify patients with elevated risk for developing cancer, resulting in improved early cancer diagnosis rates and improved prognosis for females with breast cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1259\/bjr.20190136","type":"journal-article","created":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T16:09:40Z","timestamp":1559750980000},"source":"Crossref","is-referenced-by-count":20,"title":["Detecting the \u201cgist\u201d of breast cancer in mammograms three years before localized signs of cancer are visible"],"prefix":"10.1093","volume":"92","author":[{"given":"Karla K.","family":"Evans","sequence":"first","affiliation":[{"name":"Psychology Department, University of York , York , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marie","family":"Culpan","sequence":"additional","affiliation":[{"name":"Health Education England , Halifax , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy M.","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Harvard Medical School and Brigham and Women\u2019s Hospital , Boston , MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,6,5]]},"reference":[{"key":"2024050214472632300_b1","first-page":"11","article-title":"Cancer statistics, 2013","volume":"63","author":"Siegel","year":"2013","journal-title":"CA: A Cancer Journal for Clinicians"},{"key":"2024050214472632300_b2","doi-asserted-by":"crossref","first-page":"481","DOI":"10.7326\/0003-4819-155-8-201110180-00004","article-title":"Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography","volume":"155","author":"Hubbard","year":"2011","journal-title":"Annals of Internal Medicine"},{"key":"2024050214472632300_b3","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1148\/radiology.184.3.1509041","article-title":"Analysis of cancers missed at screening mammography","volume":"184","author":"Bird","year":"1992","journal-title":"Radiology"},{"key":"2024050214472632300_b4","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1148\/rg.234025083","article-title":"Missed breast carcinoma: pitfalls and pearls","volume":"23","author":"Majid","year":"2003","journal-title":"RadioGraphics"},{"key":"2024050214472632300_b5","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.tics.2010.12.001","article-title":"Visual search in scenes involves selective and nonselective pathways","volume":"15","author":"Wolfe","year":"2011","journal-title":"Trends in Cognitive Sciences"},{"key":"2024050214472632300_b6","first-page":"573","article-title":"The cognitive side of visual search in radiology","author":"Nodine","year":"1987","journal-title":"Eye movements: From physiology to cognition"},{"key":"2024050214472632300_b7","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1148\/radiol.2422051997","article-title":"Holistic component of image perception in mammogram interpretation: Gaze-tracking study","volume":"242","author":"Kundel","year":"2007","journal-title":"Radiology"},{"key":"2024050214472632300_b8","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1016\/j.humpath.2006.08.024","article-title":"Eye-movement study and human performance using telepathology virtual slides. Implications for medical education and differences with experience","volume":"37","author":"Krupinski","year":"2006","journal-title":"Human Pathology"},{"key":"2024050214472632300_b9","first-page":"859","article-title":"The nature of expertise in radiology. Handbook of Medical Imaging","author":"Nodine","year":"2000","journal-title":"SPIE"},{"key":"2024050214472632300_b10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0066169","article-title":"The effect of expertise on eye movement behaviour in medical image perception","volume":"8","author":"Bertram","year":"2013","journal-title":"PLoS ONE"},{"key":"2024050214472632300_b11","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.3758\/s13423-013-0459-3","article-title":"The GIST of the abnormal: Above-chance medical decision making in the blink of an eye","volume":"20","author":"Evans","year":"2013","journal-title":"Psychon Bull Rev"},{"key":"2024050214472632300_b12","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/j.acra.2008.01.023","article-title":"Using gaze-tracking data and mixture distribution analysis to support a holistic model for the detection of cancers on mammograms","volume":"15","author":"Kundel","year":"2008","journal-title":"Academic Radiology"},{"key":"2024050214472632300_b13","first-page":"10","article-title":"Finding cancer in mammograms: if you know it\u2019s there, do you know where?","volume":"3","author":"Carrigan","year":"2018","journal-title":"Cognitive Research: Principles and Implications"},{"key":"2024050214472632300_b14","doi-asserted-by":"crossref","first-page":"10292","DOI":"10.1073\/pnas.1606187113","article-title":"A half-second glimpse often LETS radiologists identify breast cancer cases even when viewing the mammogram of the opposite breast","volume":"113","author":"Evans","year":"2016","journal-title":"Proceedings of the National Academy of Sciences"},{"key":"2024050214472632300_b15","doi-asserted-by":"crossref","first-page":"8717","DOI":"10.1038\/s41598-018-26100-5","article-title":"Radiologists can detect the \u2018gist\u2019 of breast cancer before any overt signs of cancer appear","volume":"8","author":"Brennan","year":"2018","journal-title":"Scientific Reports"},{"key":"2024050214472632300_b16","doi-asserted-by":"crossref","DOI":"10.4324\/9781410611147","volume-title":"Detection theory: A user's guide","author":"Macmillan","year":"2004"},{"key":"2024050214472632300_b17","volume-title":"Texture as a Diagnostic Signal in Mammograms. CogSci 2018 Conference Proceedings","author":"Semizer","year":"2018"},{"key":"2024050214472632300_b18","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1117\/12.383100","volume-title":"Medical Imaging 2000: Image Perception and Performance","author":"Kundel","year":"2000"},{"key":"2024050214472632300_b19","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1037\/a0018730","article-title":"Picture detection in RSVP: features or identity?","volume":"36","author":"Potter","year":"2011","journal-title":"J Exp Psychol Hum Percept Perform"},{"key":"2024050214472632300_b20","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/0959-4388(95)80014-X","article-title":"Binding in models of perception and brain function","volume":"5","author":"Malsburg","year":"1995","journal-title":"Current Opinion in Neurobiology"},{"key":"2024050214472632300_b21","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S0896-6273(00)80818-1","article-title":"The psychophysical evidence for a binding problem in human vision","volume":"24","author":"Wolfe","year":"1999","journal-title":"Neuron"},{"issue":"4-8","key":"2024050214472632300_b22","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1080\/13506280500195250","article-title":"How the deployment of attention determines what we see","volume":"14","author":"Treisman","year":"2006","journal-title":"Visual Cognition"},{"key":"2024050214472632300_b23","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/0042-6989(94)90300-X","article-title":"Visual search in continuous, naturalistic stimuli","volume":"34","author":"Wolfe","year":"1994","journal-title":"Vision Research"},{"key":"2024050214472632300_b24","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/S1364-6613(02)00024-4","article-title":"Moving towards solutions to some enduring controversies in visual search","volume":"7","author":"Wolfe","year":"2003","journal-title":"Trends in Cognitive Sciences"},{"key":"2024050214472632300_b25","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1037\/0096-1523.31.6.1476","article-title":"Perception of objects in natural scenes: is it really attention free?","volume":"31","author":"Evans","year":"2005","journal-title":"J Exp Psychol Hum Percept Perform"},{"key":"2024050214472632300_b26","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1126\/science.177.4043.77","article-title":"Perceiving real-world scenes","volume":"177","author":"Biederman","year":"1972","journal-title":"Science"},{"key":"2024050214472632300_b27","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/B978-012375731-9\/50045-8","article-title":"GIST of the scene","volume":"696","author":"Oliva","year":"2005","journal-title":"Neurobiology of attention"},{"key":"2024050214472632300_b28","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1038\/253437a0","article-title":"Time to understand pictures and words","volume":"253","author":"Potter","year":"1975","journal-title":"Nature"},{"key":"2024050214472632300_b29","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.tics.2011.01.003","article-title":"Representing multiple objects as an ensemble enhances visual cognition","volume":"15","author":"Alvarez","year":"2011","journal-title":"Trends in Cognitive Sciences"},{"key":"2024050214472632300_b30","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.cogpsych.2008.06.001","article-title":"Recognition of natural scenes from global properties: seeing the forest without representing the trees","volume":"58","author":"Greene","year":"2009","journal-title":"Cognitive Psychology"},{"key":"2024050214472632300_b31","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1177\/0956797611407930","article-title":"When categories collide: accumulation of information about multiple categories in rapid scene perception","volume":"22","author":"Evans","year":"2011","journal-title":"Psychol Sci"},{"key":"2024050214472632300_b32","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1023\/A:1011139631724","article-title":"Modeling the shape of the scene: a holistic representation of the spatial envelope","volume":"42","author":"Oliva","year":"2001","journal-title":"International Journal of Computer Vision"},{"key":"2024050214472632300_b33","doi-asserted-by":"crossref","first-page":"024501","DOI":"10.1117\/1.JMI.2.2.024501","article-title":"Parenchymal texture analysis in digital mammography: robust texture feature identification and equivalence across devices","volume":"2","author":"Keller","year":"2015","journal-title":"J Med Imaging"},{"key":"2024050214472632300_b34","doi-asserted-by":"crossref","first-page":"e0189828","DOI":"10.1371\/journal.pone.0189828","article-title":"Scene content is predominantly conveyed by high spatial frequencies in scene-selective visual cortex","volume":"12","author":"Berman","year":"2017","journal-title":"Plos One"},{"key":"2024050214472632300_b35","doi-asserted-by":"crossref","first-page":"031917","DOI":"10.1118\/1.4865811","article-title":"Pilot study demonstrating potential association between breast cancer image-based risk phenotypes and genomic biomarkers","volume":"41","author":"Li","year":"2014","journal-title":"Med Phys"},{"key":"2024050214472632300_b36","article-title":"Relationships between computer-extracted mammographic texture pattern features and BRCA1\/2 mutation status: a cross-sectional study","volume":"16","author":"Gierach","year":"2014","journal-title":"Breast Cancer Res"},{"key":"2024050214472632300_b37","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0064366","article-title":"If you don\u2019t find it often, you often don\u2019t find it: Why some cancers are missed in breast cancer screening","volume":"8","author":"Evans","year":"2013","journal-title":"PLoS ONE"},{"key":"2024050214472632300_b38","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1109\/TMI.2016.2532122","article-title":"Unsupervised deep learning applied to breast density segmentation and mammographic risk scoring","volume":"35","author":"Kallenberg","year":"2016","journal-title":"IEEE Trans. Med. Imaging"},{"key":"2024050214472632300_b39","doi-asserted-by":"crossref","first-page":"034501","DOI":"10.1117\/1.JMI.3.3.034501","article-title":"Digital mammographic tumor classification using transfer learning from deep convolutional neural networks","volume":"3","author":"Huynh","year":"2016","journal-title":"J Med Imaging"}],"container-title":["The British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/92\/1099\/20190136\/57378173\/bjr.20190136.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/92\/1099\/20190136\/57378173\/bjr.20190136.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T11:05:50Z","timestamp":1714647950000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/article\/doi\/10.1259\/bjr.20190136\/7451941"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,6,5]]},"references-count":39,"journal-issue":{"issue":"1099","published-online":{"date-parts":[[2019,6,5]]},"published-print":{"date-parts":[[2019,7,1]]}},"URL":"https:\/\/doi.org\/10.1259\/bjr.20190136","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,7,1]]},"published":{"date-parts":[[2019,6,5]]},"article-number":"20190136"}}