The TNM staging system for cancer was developed by Pierre Denoix in France in the 1940s and 1950s. The North American effort to standardize the TNM system for cancer staging was first organized in 1959 as the American Joint Committee for Cancer Staging and End-Results Reporting, which is now the American Joint Committee on Cancer (AJCC). The most recent edition of the AJCC Cancer Staging Manual, the eighth edition, was globally adopted on January 1, 2018. Previous editions of the manual have relied on anatomic methods of staging alone, which used population-based survival data to predict clinical outcomes. In the era of precision medicine, the major change in the eighth edition is the incorporation of prognostic biomarkers to more accurately predict clinical outcomes and treatment response on an individual basis, without relying solely on the anatomic extent of disease. Factors such as tumor grade, hormone receptor and oncogene expression, and multigene panel recurrence scores are now integrated with anatomic information to yield a final prognostic stage group, which will provide better stratification of patient prognosis. The purpose of this article is to review the major changes in the AJCC eighth edition for breast cancer staging, review anatomic TNM staging, familiarize the radiologist with prognostic biomarkers and prognostic staging, and identify key sites of disease that may alter clinical management. ©

Question: How can we determine optimum recall rates in breast cancer screening? Findings: In this large observational study we show that increases in recall rates above defined levels are almost exclusively associated with false positive recalls and a very small increase in low/intermediate grade DCIS. Meaning: High recall rates are not associated with increases in detection of life threatening cancers. The models developed in this paper can be used to help set recall rate ranges that maximise benefit and minimise harm. Abbreviations NHSBSP National Health Service Breast Screening Programme MMV Modelled maximum value MS Modelled Slope (how rapidly MMV is reached) P95 Recall rate at which 95% of MMV is reached DCIS Ductal carcinoma in situ SEER The Surveillance, Epidemiology and End Results program of the National Cancer Institute AgeX trial Age extension trial KC62 Korner return used to collect NHS data (breast screening return is no. 62

The NHS Breast Screening Programme (NHSBSP) was started in 1988 and is a large, organised cancer screening programme. It is delivered by 80 services across England and screens over 2 million women each year. As a screening programme, it must balance the detection of cancers against possible harm to women who do not have cancer. The NHSBSP was therefore designed with detailed information gathering and performance metrics right from the start. In this review paper, we examine how performance metrics in screening mammography have improved the national screening programme and the further developments and challenges that are expected in the years to come.