The sensitivity, specificity, and positive predictive value of screening mammography and symptomatic status

Objective: Published screening mammography performance measures vary across countries. An international study was undertaken to assess the comparability of two performance measures: the recall rate and positive predictive value (PPV). These measures were selected because they do not require identification of all cancers in the screening population, which is not always possible. Setting:The screening mammography programs or data registries in 25 member countries of the International Breast Cancer Screening Network (IBSN). Methods:In 1999 an assessment form was distributed to IBSN country representatives in order to obtain information on how screening mammography was performed and what specific data related to recall rates and PPV were collected. Participating countries were then asked to provide data to allow calculation of recall rates, PPV and cancer detection rates for screening mammography by age group for women screened in the period 1997-1999.Results: Twenty-two countries completed the assessment form and 14 countries provided performance data. Differences in screening mammography delivery and data collection were evident. For most countries, recall rates were higher for initial than for subsequent mammograms. There was no consistent relationship of initial to subsequent PPV, although PPV generally decreased as the recall rate increased. Recall rates decreased with increasing age, while PPV increased as age increased. Conclusion:Similar patterns for mammography performance measures were evident across countries.However, the development of a more standardized approach to defining and collecting data would allow more valid international comparisons, with the potential to optimize mammography performance. At present, international comparisons of performance should be made with caution due to differences in defining and collecting mammography data.

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“…Recall and PPV are known to differ by screening interval and whether a screening mammogram is the initial or a subsequent study. 9,13,14,29 …”

Section: Phase IIImentioning

confidence: 99%

International comparison of performance measures for screening mammography: can it be done?

Yankaskas

Ancelle-Park

et al. 2004

J Med Screen

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“…3,[5][6][7]10 Although screening is typically conducted among asymptomatic women, one study has reported that approximately 10% of women report symptoms at a screening examination. 11 It is not clear how much the presence of symptoms increases the risk of breast cancer at screening exams. This is particularly important because studies have shown that the specificity of screening and diagnostic exams may be lower for women with breast symptoms compared with women without symptoms.…”

mentioning

confidence: 99%

Rate of Breast Cancer Diagnoses among Postmenopausal Women with Self-Reported Breast Symptoms

Aiello

Buist

White

et al. 2004

The Journal of the American Board of Family Medicine

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Background: Breast cancer rates in women with multiple breast symptoms have not been well described.Methods: We examined the association between self-reported symptoms (lump, nipple discharge, pain, other) and breast cancer risk for screening and diagnostic mammograms in 57,681 women. Subanalyses evaluated risk among women with no prior mammograms, new symptoms, and repeated symptoms. One thousand, three hundred and eighty-nine women were diagnosed with cancer within 12 months of their mammograms. We calculated the breast cancer rate for each symptom and odds ratios (OR) with 95% confidence intervals (CI) for breast cancer among symptomatic women compared with asymptomatic women.Results: Women reporting a lump had an increased odds of breast cancer compared with asymptomatic women (OR for diagnostic examination ‫؍‬ 2.8, 95% CI ‫؍‬ 2.3 to 3.4; OR for screening examination ‫؍‬ 3.6, 95% CI ‫؍‬ 2.6 to 5.0). No other symptoms were associated with breast cancer after controlling for a reported lump. A new lump at a diagnostic examination was significantly predictive of cancer among women with no prior mammograms (OR ‫؍‬ 12.2, 95% CI ‫؍‬ 2.8 to 53.5); reporting symptoms at 2 successive exams had little effect on breast cancer risk (OR for lump ‫؍‬ 1.2, 95% CI ‫؍‬ 0.6 to 2.5).Conclusions: Having a lump is the most predictive symptom of breast cancer whether it is reported at a screening or diagnostic examination or in conjunction with other symptoms.

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“…The trade- Table 1: Results of mammogram (Mx) and ultrasound (US) screening from the parallel assessment study of Houssami et al [16] and mammogram baseline data from Kavanagh et al [17].…”

Section: Believe the Positive Protocolmentioning

confidence: 99%

“…The MLEs of the sensitivity and specificity of the believe the negative protocol and of the log-ratios of the likelihood ratios are obtained by substituting the MLEs given in Equation (20) into Equations (16)(17)(18)(19).…”

Section: Analysis For the Believe The Negative Protocolmentioning

confidence: 99%

“…Based on the paired data in Table 1 In order to proceed with the methods described in the previous section, we need baseline data on the performance of mammography in the given population. We use the data provided in Kavanagh et al [17] for this purpose (see Table 1-Baseline data) which provide estimates of the sensitivity and specificity of mammography in a similar symptomatic population. We consider the subpopulation of women with any breast symptoms and estimate the sensitivity and specificity of mammography to be 71.0% and 89.7%, respectively.…”

Section: Applicationmentioning

confidence: 99%

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Using Available Information in the Assessment of Diagnostic Pro tocols

Cotton¹

2015

J Biom Biostat

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A new binary screening or diagnostic test may be combined sequentially with an existing test using either a believe the positive or believe the negative protocol. Interest then lies in estimating the properties of the new combined protocol and in comparing the new protocol with the existing test via sensitivity, specificity, or likelihood ratios that capture the trade-off between sensitivity and specificity. We consider a paired assessment study with complete verification via a gold standard. Our goal is to quantify the gain in precision for the estimators of the sensitivity, specificity and the ratio of likelihood ratios in protocols when baseline information on the performance of the existing test is available. We find maximum likelihood estimators of the quantities of interest and derive their asymptotic standard deviations. The methods are illustrated using previously published mammography and ultrasound test results from a cohort of symptomatic women. We find that incorporating baseline information has a large impact on the precision of the estimator for the specificity of the believe the positive protocol and of the sensitivity of the believe the negative protocol. Including available baseline information can improve the precision of estimators of the sensitivity, specificity, and the ratio of likelihood ratios and/or reduce the number of subjects needed in an assessment study to evaluate the protocol.Citation:

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The sensitivity, specificity, and positive predictive value of screening mammography and symptomatic status

Cited by 48 publications

References 36 publications

International comparison of performance measures for screening mammography: can it be done?

International comparison of performance measures for screening mammography: can it be done?

Rate of Breast Cancer Diagnoses among Postmenopausal Women with Self-Reported Breast Symptoms

Using Available Information in the Assessment of Diagnostic Pro tocols

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