title: Value of audits in breast cancer screening quality assurance programmes.
abstract: OBJECTIVE
  Our aim was to retrospectively evaluate the results of all audits performed in the past and to assess their value in the quality assurance of the Dutch breast cancer screening programme.
  
  
  METHODS
  The audit team of the Dutch Reference Centre for Screening (LRCB) conducts triennial audits of all 17 reading units. During audits, screening outcomes like recall rates and detection rates are assessed and a radiological review is performed. This study investigates and compares the results of four audit series: 1996-2000, 2001-2005, 2003-2007 and 2010-2013.
  
  
  RESULTS
  The analysis shows increased recall rates (from 0.66%, 1.07%, 1.22% to 1.58%), increased detection rates (from 3.3, 4.5, 4.8 to 5.4 per 1000) and increased sensitivity (from 64.5%, 68.7%, 70.5% to 71.6%), over the four audit series. The percentage of 'missed cancers' among interval cancers and advanced screen-detected cancers did not change (p = 0.4).
  
  
  CONCLUSIONS
  Our audits not only provide an opportunity for assessing screening outcomes, but also provide moments of self-reflection with peers. For radiologists, an accurate understanding of their performance is essential to identify points of improvement. We therefore recommend a radiological review of screening examinations and immediate feedback as part of an audit.
  
  
  CONCLUSIONS
  • Radiological review and immediate feedback are recommended as part of an audit. • For breast screening radiologists, audits provide moments of self-reflection with peers. • Radiological review of screening examinations provides insights in recall behaviour. • Accurate understanding of radiologists' performance is essential to identify points of improvement.
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands. t.geertse@lrcb.nl.
authors.forename: Tanya D
authors.initials: TD
authors.lastname: Geertse
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands.
authors.forename: Roland
authors.initials: R
authors.lastname: Holland
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands.
authors.forename: Janine M H
authors.initials: JM
authors.lastname: Timmers
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands.
authors.forename: Ellen
authors.initials: E
authors.lastname: Paap
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands.|Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Ruud M
authors.initials: RM
authors.lastname: Pijnappel
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands.|Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Mireille J M
authors.initials: MJ
authors.lastname: Broeders
authors.affiliation: Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands.|Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: den Heeten
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002983:Clinical Competence / Q000592:standards; D055088:Early Detection of Cancer / Q000592:standards; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008403:Mass Screening / Q000379:methods / Q000592:standards; D008485:Medical Audit; D008875:Middle Aged; D009426:Netherlands; D011785:Quality Assurance, Health Care; D011871:Radiology / Q000592:standards; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Mammography; Mass screening; Medical audit; Peer review; Quality assurance