Association of recall rates with sensitivity and positive predictive values of screening mammography

OBJECTIVE. The performance of screening mammography is measured mainly by i ts sensitivity, positive predictive value, and cancer detection rate. Recal l rates are also suggested as a surrogate measure. The main objective of th is study was to measure the effect on sensitivity and positive predictive v alue as recall rates increase in the community practice of mammography. MATERIALS AND METHODS. Mammography and pathology data are linked in the Car olina Mammography Registry, a population-based registry of screening mammog raphy. Our mammography database is created from prospectively collected dat a from mammography facilities; the data include information on the woman an d the imaging studies. Our pathology database is created from prospectively collected breast pathology data received from pathology sites and the Cent ral Cancer Registry. Women in the registry who were 40 years old and older and who underwent screening mammography between January 1994 and June 1998 were included. "Recall rate" was defined as the percentage of screening stu dies for which further workup was recommended by the radiologist. RESULTS. The study included 215,665 screening mammograms. The mean age of t he women was 56 years. The recall rates of the average practice ranged from 1.9% to 13.4%. Sensitivity rose from a mean of 65% in the lowest recall ra tes to 80.2% at the highest level of recall rates. The positive predictive value of screening decreased from 7.2% in the lowest level of recall to 3.3 % in the highest. As recall rates increased, sensitivity increased very lit tle beyond a recall rate of 4.8%, and positive predictive value began decre asing significantly at a recall rate of 5.9%. CONCLUSION. Practices with recall rates between 4.9% and 5.5% achieve the b est trade-off of sensitivity and positive predictive value.