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Purpose: Controversy continues regarding the effect of screening mammography on breast cancer outcomes. We evaluated late-stage cancer rate and overall survival (OS) for different screening intervals using a real-world institutional research data mart., Methods: Patients having both a cancer registry record of new breast cancer diagnosis and prediagnosis screening history between 2004 and 2019 were identified from our institutional research breast data mart. Time interval between the two screening mammograms immediately preceding diagnosis and the time to cancer diagnosis were determined. Screening interval was deemed annual if ≤15 months, biennial if >15 and ≤27 months, intermittent if >27 months, and baseline if only one prediagnosis screen was known. The primary end point was late-stage cancer (TNM stage IIB or worse), and the secondary end point was OS. The association of screening interval and late-stage cancer was analyzed using multivariable logistic regression adjusting for prediagnosis characteristics. Proportional hazards regression was used for survival analysis. Potential lead time was analyzed using survival from a uniform fixed time point., Results: In total, 8,145 patients with breast cancer had prediagnosis screening mammography in the timeframe. The percentage of late-stage cancers diagnosed increased significantly with screening interval with 9%, 14%, and 19% late stages for annual, biennial, and intermittent groups ( P < .001), respectively. The trend persisted regardless of age, race, and menopausal status. Biennial and intermittent groups had substantially worse OS than the annual screened group, with relative hazards of 1.42 (95% CI, 1.11 to 1.82) and 2.69 (95% CI, 2.11 to 3.43), respectively, and 1.39 (95% CI, 1.08 to 1.78) and 2.01 (95% CI, 1.58 to 2.55) after adjustment for potential lead time., Conclusion: Annual mammographic screening was associated with lower risk of late-stage cancer and better OS across clinical and demographic subgroups. Our study suggests benefit of annual screening for women 40 years and older.

Background Studies suggest that readers experience perceptual adaptation when interpreting batched screening mammograms, which may serve as a mechanism for improved performance. Purpose To analyze clinical digital breast tomosynthesis (DBT) screening data to evaluate changes in reader performance during sequential batch reading. Materials and Methods This observational retrospective study used data from the radiology information system collected for screening DBT examinations performed from January 2018 to December 2019. The reference standard was established based on pathology results, if applicable, or imaging findings at 1-year follow-up. Examinations were aggregated into batches, defined as a sequence of cases for a given reader with differences in interexamination time of 10 minutes or less. Mixed-effect models were used to evaluate performance and timing across batch positions. Statistical adjustments accounted for potential confounders, including patient characteristics (age, breast density), reading factors (day of week, time of day), and between-reader heterogeneity. Results The dataset included 121 652 examinations (median patient age, 61 years [IQR, 53-69 years]), including 1081 cancers interpreted by 15 radiologists. Unadjusted false-positive rates decreased from an averaged 15.5% at the first within-batch examination to 10.5% after three sequentially read examinations ( P < .001), without a significant change in sensitivity (82.6% vs 84.2%; P = .15). The interpretation time consistently decreased, achieving a substantial reduction in longer batches (average 2.8 to 2.2 minutes for noncancer examinations; P < .001). Adjustment for sampling bias and confounders (patient age, breast density, day of week, time of day; all P < .005) reduced the effect on false-positive rates (11.5% to 9.4% after three examinations; P < .001) and interpretation time (3.2 to 2.7 minutes for noncancer examinations; P < .001). Conclusion Radiologists showed improved recall rates and interpretation times without change in sensitivity over the course of batch reading of DBT screening examinations. © RSNA, 2024 See also the editorial by Iima and Satake in this issue.

Background Digital breast tomosynthesis (DBT) is often inadequate for screening women with a personal history of breast cancer (PHBC). The ongoing prospective Tomosynthesis or Contrast-Enhanced Mammography, or TOCEM, trial includes three annual screenings with both DBT and contrast-enhanced mammography (CEM). Purpose To perform interim assessment of cancer yield, stage, and recall rate when CEM is added to DBT in women with PHBC. Materials and Methods From October 2019 to December 2022, two radiologists interpreted both examinations: Observer 1 reviewed DBT first and then CEM, and observer 2 reviewed CEM first and then DBT. Effects of adding CEM to DBT on incremental cancer detection rate (ICDR), cancer type and node status, recall rate, and other performance characteristics of the primary radiologist decisions were assessed. Results Among the participants (mean age at entry, 63.6 years ± 9.6 [SD]), 1273, 819, and 227 women with PHBC completed year 1, 2, and 3 screening, respectively. For observer 1, year 1 cancer yield was 20 of 1273 (15.7 per 1000 screenings) for DBT and 29 of 1273 (22.8 per 1000 screenings; ICDR, 7.1 per 1000 screenings [95% CI: 3.2, 13.4]) for DBT plus CEM ( P < .001). Year 2 plus 3 cancer yield was four of 1046 (3.8 per 1000 screenings) for DBT and eight of 1046 (7.6 per 1000 screenings; ICDR, 3.8 per 1000 screenings [95% CI: 1.0, 7.6]) for DBT plus CEM ( P = .001). Year 1 recall rate for observer 1 was 103 of 1273 (8.1%) for (incidence) DBT alone and 187 of 1273 (14.7%) for DBT plus CEM (difference = 84 of 1273, 6.6% [95% CI: 5.3, 8.1]; P < .001). Year 2 plus 3 recall rate was 40 of 1046 (3.8%) for DBT and 92 of 1046 (8.8%) for DBT plus CEM (difference = 52 of 1046, 5.0% [95% CI: 3.7, 6.3]; P < .001). In 18 breasts with cancer detected only at CEM after integration of both observers, 13 (72%) cancers were invasive (median tumor size, 0.6 cm) and eight of nine (88%) with staging were N0. Among 1883 screenings with adequate reference standard, there were three interval cancers (one at the scar, two in axillae). Conclusion CEM added to DBT increased early breast cancer detection each year in women with PHBC, with an accompanying approximately 5.0%-6.6% recall rate increase. Clinical trial registration no. NCT04085510 © RSNA, 2024 Supplemental material is available for this article.

Purpose: In the United States, a comprehensive national breast cancer registry (CR) does not exist. Thus, care and coverage decisions are based on data from population subsets, other countries, or models. We report a prototype real-world research data mart to assess mortality, morbidity, and costs for breast cancer diagnosis and treatment., Methods: With institutional review board approval and Health Insurance Portability and Accountability Act (HIPPA) compliance, a multidisciplinary clinical and research data warehouse (RDW) expert group curated demographic, risk, imaging, pathology, treatment, and outcome data from the electronic health records (EHR), radiology (RIS), and CR for patients having breast imaging and/or a diagnosis of breast cancer in our institution from January 1, 2004, to December 31, 2020. Domains were defined by prebuilt views to extract data denormalized according to requirements from the existing RDW using an export, transform, load pattern. Data dictionaries were included. Structured query language was used for data cleaning., Results: Five-hundred eighty-nine elements (EHR 311, RIS 211, and CR 67) were mapped to 27 domains; all, except one containing CR elements, had cancer and noncancer cohort views, resulting in a total of 53 views (average 12 elements/view; range, 4-67). EHR and RIS queries returned 497,218 patients with 2,967,364 imaging examinations and associated visit details. Cancer biology, treatment, and outcome details for 15,619 breast cancer cases were imported from the CR of our primary breast care facility for this prototype mart., Conclusion: Institutional real-world data marts enable comprehensive understanding of care outcomes within an organization. As clinical data sources become increasingly structured, such marts may be an important source for future interinstitution analysis and potentially an opportunity to create robust real-world results that could be used to support evidence-based national policy and care decisions for breast cancer.

Sensory systems continuously recalibrate their responses according to the current stimulus environment. As a result, perception is strongly affected by the current and recent context. These adaptative changes affect both sensitivity (e.g., habituating to noise, seeing better in the dark) and appearance (e.g. how things look, what catches attention) and adjust to many perceptual properties (e.g. from light level to the characteristics of someone's face). They therefore have a profound effect on most perceptual experiences, and on how and how well the senses work in different settings. Characterizing the properties of adaptation, how it manifests, and when it influences perception in modern environments can provide insights into the diversity of human experience . Adaptation could also be leveraged both to optimize perceptual abilities (e.g. in visual inspection tasks like radiology) and to mitigate unwanted consequences (e.g. exposure to potentially unhealthy stimulus environments).