Background False-positive mammography results are common. Biennial screening may decrease the cumulative probability of false-positive results across many years of repeat screening but could also delay cancer diagnosis. Objective To compare the cumulative probability of false-positive results and the stage distribution of incident breast cancer after 10 years of annual or biennial screening mammography. Design Prospective cohort. Setting Seven mammography registries in the National Cancer Institute–funded Breast Cancer Surveillance Consortium. Participants 169,456 women who received a first screening mammogram at age 40–59 between 1994 and 2006 and 4,492 women with an incident invasive breast cancer diagnosed between 1996 and 2006. Measurements False-positive recalls and biopsy recommendations; stage distribution of incident breast cancer. Results False-positive recall probability was 16.3% at first and 9.6% at subsequent mammography. False-positive biopsy recommendation probability was 2.5% at first and 1.0% at subsequent examinations. Availability of comparison films halved the odds of a false-positive recall (adjusted OR 0.50 (CI 0.45, 0.56)). When screening began at age 40, the cumulative probability of a woman receiving at least one false-positive recall after 10 years was 61.3% (95% CI, 59.4% to 63.1%) with annual and 41.6% (CI, 40.6% to 42.5%) with biennial screening. Cumulative probability of false-positive biopsy recommendation was 7.0% (CI, 6.1% to 7.8%) with annual and 4.8% (CI, 4.4% to 5.2%) with biennial screening. Estimates were comparable when screening began at age 50. We observed a non-statistically significant increase in the proportion of late-stage cancers with biennial compared to annual screening (absolute increase 3.3% (CI −1.1, 7.8) age 40–49, 2.3% (CI −1.0, 5.7) age 50–59) among a population of women with incident breast cancer. Limitations Few women underwent screening over the entire 10 year period. Radiologist characteristics influence recall rates and were unavailable. Most mammograms were film rather than digital exams. Incident cancers were analyzed in a small population of women who developed cancer. Conclusions After 10 years of annual screening, more than half of women will receive at least one false-positive recall, and 7–9% will receive a false-positive biopsy recommendation. Biennial screening appears to reduce the cumulative probability of false-positive results after 10 years but may be associated with a small absolute increase in the probability of being diagnosed with late stage cancer.

Background Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice. Objective To determine whether the interpretive performance of digital and film-screen mammography differs. Design Prospective cohort study. Setting Mammography facilities in the Breast Cancer Surveillance Consortium. Participants 329 261 women aged 40 to 79 years underwent 869 286 mammograms (231 034 digital; 638 252 film-screen). Measurements Invasive cancer or ductal carcinoma in situ diagnosed within 12 months of a digital or film-screen examination and calculation of mammography sensitivity, specificity, cancer detection rates, and tumor outcomes. Results Overall, cancer detection rates and tumor characteristics were similar for digital and film-screen mammography, but the sensitivity and specificity of each modality varied by age, tumor characteristics, breast density, and menopausal status. Compared with film-screen mammography, the sensitivity of digital mammography was significantly higher for women aged 60 to 69 years (89.9% vs. 83.0%; P = 0.014) and those with estrogen receptor-negative cancer (78.5% vs. 65.8%; P = 0.016); borderline significantly higher for women aged 40 to 49 years (82.4% vs. 75.6%; P = 0.071), those with extremely dense breasts (83.6% vs. 68.1%; P= 0.051), and pre- or perimenopausal women (87.1% vs. 81.7%; P = 0.057); and borderline significantly lower for women aged 50 to 59 years (80.5% vs. 85.1%; P = 0.097). The specificity of digital and film-screen mammography was similar by decade of age, except for women aged 40 to 49 years (88.0% vs. 89.7%; P< 0.001). Limitation Statistical power for subgroup analyses was limited. Conclusion Overall, cancer detection with digital or film-screen mammography is similar in U.S. women aged 50 to 79 years undergoing screening mammography. Women aged 40 to 49 years are more likely to have extremely dense breasts and estrogen receptor-negative tumors; if they are offered mammography screening, they may choose to undergo digital mammography to optimize cancer detection. Primary Funding Source National Cancer Institute.

Background and Aims Patients with cirrhosis are at increased risk of postoperative mortality. Currently available tools to predict postoperative risk are suboptimally calibrated and do not account for surgery type. Our objective was to use population‐level data to derive and internally validate cirrhosis surgical risk models. Approach and Results We conducted a retrospective cohort study using data from the Veterans Outcomes and Costs Associated with Liver Disease (VOCAL) cohort, which contains granular data on patients with cirrhosis from 128 U.S. medical centers, merged with the Veterans Affairs Surgical Quality Improvement Program (VASQIP) to identify surgical procedures. We categorized surgeries as abdominal wall, vascular, abdominal, cardiac, chest, or orthopedic and used multivariable logistic regression to model 30‐, 90‐, and 180‐day postoperative mortality (VOCAL‐Penn models). We compared model discrimination and calibration of VOCAL‐Penn to the Mayo Risk Score (MRS), Model for End‐Stage Liver Disease (MELD), Model for End‐Stage Liver Disease‐Sodium MELD‐Na, and Child‐Turcotte‐Pugh (CTP) scores. We identified 4,712 surgical procedures in 3,785 patients with cirrhosis. The VOCAL‐Penn models were derived and internally validated with excellent discrimination (30‐day postoperative mortality C‐statistic = 0.859; 95% confidence interval [CI], 0.809‐0.909). Predictors included age, preoperative albumin, platelet count, bilirubin, surgery category, emergency indication, fatty liver disease, American Society of Anesthesiologists classification, and obesity. Model performance was superior to MELD, MELD‐Na, CTP, and MRS at all time points (e.g., 30‐day postoperative mortality C‐statistic for MRS = 0.766; 95% CI, 0.676‐0.855) in terms of discrimination and calibration. Conclusions The VOCAL‐Penn models substantially improve postoperative mortality predictions in patients with cirrhosis. These models may be applied in practice to improve preoperative risk stratification and optimize patient selection for surgical procedures (http://www.vocalpennscore.com).

Key Points Question Are cardiovascular risk factors assessed and appropriately managed in patients with prostate cancer initiating androgen deprivation therapy? Findings In this cross-sectional analysis of 90 494 US veterans with prostate cancer, 68.1% received comprehensive cardiovascular risk factor assessment and 54.1% had uncontrolled risk factors; of these, 29.6% were not receiving risk-reducing medication. Patients with known atherosclerotic cardiovascular disease had improved cardiovascular risk factor assessment, control, and treatment; however, androgen deprivation therapy initiation was not associated with meaningful differences in these outcomes. Meaning In this study, veterans with prostate cancer, including those initiating androgen deprivation therapy, appeared to have a high burden of underassessed and undertreated cardiovascular risk factors.

Key Points Question Is there a difference between screening with digital breast tomosynthesis vs digital mammography in the probability of false-positive results after 10 years of screening? Findings In this comparative effectiveness study of 903 495 individuals undergoing 2 969 055 screening examinations, the 10-year cumulative probability of receiving at least 1 false-positive recall was 6.7% lower for tomosynthesis vs digital mammography with annual screening and 2.4% lower for tomosynthesis vs digital mammography with biennial screening, a significant difference. Meaning The findings of this study suggest that digital breast tomosynthesis is associated with a lower cumulative probability of false-positive results compared with digital mammography; biennial vs annual screening was associated with larger reductions in cumulative false-positive risk for both modalities.