title: The outcome of a quality-controlled mammography screening program: experience from a population-based study in Taiwan.
abstract: BACKGROUND
  A greater policy of emphasis on the early detection and treatment of breast cancer is prevalent among developed countries. To raise the screening performance with a potentially decreased mortality rate, it is crucial to evaluate and analyze the screening outcome after implementation. We report the clinical outcome of an 8-year nationwide mammography screening in Taiwan to help share our statistical information on breast screening worldwide, especially in Asia.
  
  
  METHODS
  Taiwan has provided nationwide, free, biennial mammographic screening since 2004. A total of 2,392,789 consecutive screening mammography examinations were performed during this study period for women aged 50-69 years (2006-2009) and 45-69 years (from December 2009 onwards). The screening covers 33.2% of the target population in the most recent 2 years. The workload of every screening radiologist, the overall recall rate, positive predictive value (PPV1), cancer detection rate (CDR), cancer incidence rate (CIR) from the screening, 1-year interval cancer, sensitivity, and specificity of the screening mammography are calculated, and compared with the American College of Radiology (ACR) recommendation level and/or those of other screening mammographic series.
  
  
  RESULTS
  The CDRs (%) and CIRs (%) increased from 3.94-4.08 and 4.80-5.04 to 4.71-5.04 and 5.71 after 2009, implying a high occurrence of breast cancer in the younger age group of 45-49 years. The recall rates (9.3-10.0%) in this review are within the ACR recommendation range (<10%) and the PPV1 has also reached the ACR recommended level (>5%) in the most recent 2 years. The improvement of the screening performance may be attributed to our peer auditing review and education program. The sensitivity of our screening mammography is slightly lower than that of the ACR recommended level (>85%), which is still comparable to the results of the Vermont area in the USA. Although the workload (screenees/screeners) for every radiologist each year has increased from 150 in 2004 to 1360 in 2012, it does not seem to worsen the quality outcome of this screening program.
  
  
  CONCLUSIONS
  From the outcome review of this national mammography screening, there is still room to ameliorate our performance through comprehensive and continued education, to improve the competence of cancer detection and decrease false negative (FN) cases.
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Huay-Ben
authors.initials: HB
authors.lastname: Pan
authors.affiliation: Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan, ROC.
authors.forename: Kam-Fai
authors.initials: KF
authors.lastname: Wong
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Tsung-Lung
authors.initials: TL
authors.lastname: Yang
authors.affiliation: Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan, ROC.
authors.forename: Giu-Cheng
authors.initials: GC
authors.lastname: Hsu
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Chen-Pin
authors.initials: CP
authors.lastname: Chou
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Jer-Shyung
authors.initials: JS
authors.lastname: Huang
authors.affiliation: Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
authors.forename: San-Kan
authors.initials: SK
authors.lastname: Lee
authors.affiliation: National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yi-Hong
authors.initials: YH
authors.lastname: Chou
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Chiang
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: hlliang@vghks.gov.tw.
authors.forename: Huei-Lung
authors.initials: HL
authors.lastname: Liang
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011237:Predictive Value of Tests
keywords: breast screening; cancer detection rate; mammographic screening; medical audit; sensitivity