title: Is breast compression associated with breast cancer detection and other early performance measures in a population-based breast cancer screening program?
abstract: OBJECTIVE
  We aimed to investigate early performance measures in a population-based breast cancer screening program stratified by compression force and pressure at the time of mammographic screening examination. Early performance measures included recall rate, rates of screen-detected and interval breast cancers, positive predictive value of recall (PPV), sensitivity, specificity, and histopathologic characteristics of screen-detected and interval breast cancers.
  
  
  METHODS
  Information on 261,641 mammographic examinations from 93,444 subsequently screened women was used for analyses. The study period was 2007-2015. Compression force and pressure were categorized using tertiles as low, medium, or high. χ2test, t tests, and test for trend were used to examine differences between early performance measures across categories of compression force and pressure. We applied generalized estimating equations to identify the odds ratios (OR) of screen-detected or interval breast cancer associated with compression force and pressure, adjusting for fibroglandular and/or breast volume and age.
  
  
  RESULTS
  The recall rate decreased, while PPV and specificity increased with increasing compression force (p for trend <0.05 for all). The recall rate increased, while rate of screen-detected cancer, PPV, sensitivity, and specificity decreased with increasing compression pressure (p for trend <0.05 for all). High compression pressure was associated with higher odds of interval breast cancer compared with low compression pressure (1.89; 95% CI 1.43-2.48).
  
  
  CONCLUSIONS
  High compression force and low compression pressure were associated with more favorable early performance measures in the screening program.
authors.affiliation: Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304, Oslo, Norway.
authors.forename: Nataliia
authors.initials: N
authors.lastname: Moshina
authors.affiliation: Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304, Oslo, Norway.
authors.forename: Sofie
authors.initials: S
authors.lastname: Sebuødegård
authors.affiliation: Cancer Registry of Norway, P.O. 5313, Majorstuen, 0304, Oslo, Norway. solveig.hofvind@kreftregisteret.no.|Faculty of Health Science, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. solveig.hofvind@kreftregisteret.no.
authors.forename: Solveig
authors.initials: S
authors.lastname: Hofvind
mesh_terms: D000368:Aged; D001940:Breast / Q000000981:diagnostic imaging*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged
keywords: Breast cancer screening; Breast compression; Early performance measures; Mammography