title: Evidence-based target recall rates for screening mammography.
abstract: OBJECTIVE
  To retrospectively identify target recall rates for screening mammography on the basis of how sensitivity shifts with recall rate.
  
  
  METHODS
  The study group included 1 872 687 subsequent and 171 104 first screening mammograms from 1996 to 2001 from 172 and 139 facilities, respectively, in six sites of the Breast Cancer Surveillance Consortium. Institutional review board (IRB) approval was obtained from each site. Informed consent requirements of the IRBs were followed. The study was HIPAA compliant. Recall rate was defined as the percentage of screening studies for which further work-up was recommended by the radiologist. Sensitivity was defined as the proportion of cancers that were detected at screening mammography. Piecewise linear regression was used to model sensitivity as a function of recall rate. This model allows detection of critical recall rates in which significant changes (shifts) occurred in the rates that sensitivity increased with increasing recall rate. Rates were interpreted as number of additional work-ups per additional cancer detected (AW/ACD) or, in other words, the estimated number of additional women needed to be recalled at a given rate to detect one additional cancer.
  
  
  RESULTS
  For first mammograms, a single shift in the estimated AW/ACD rate occurred at a recall rate of 10.0%, with the rate jumping dramatically from 35 to 172. For subsequent mammograms, four shifts were identified. At a recall rate of 6.7%, the estimated AW/ACD increased from 80 to 132, which rendered it the highest desirable target recall rate. At a recall rate of 12.3%, the estimated AW/ACD was 304, which suggests little benefit for any higher recall rate.
  
  
  CONCLUSIONS
  Recall rates of 10.0% for first and 6.7% for subsequent mammograms are recommended targets on the basis of their AW/ACD rates (less than 100).
authors.affiliation: Biostatistics Division, Department of Interdisciplinary Oncology, Moffitt Research Center, 12902 Magnolia Dr, Tampa, FL 33612-9497, USA. michael.schell@moffitt.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schell
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Yankaskas
authors.forename: Rachel
authors.initials: R
authors.lastname: Ballard-Barbash
authors.forename: Bahjat F
authors.initials: BF
authors.lastname: Qaqish
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.forename: Robert D
authors.initials: RD
authors.lastname: Rosenberg
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith-Bindman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D019317:Evidence-Based Medicine; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology