Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. ORIGINAL RESEARCH n BREAST IMAGING 74 radiology.rsna.org n Radiology: Volume 256: Number 1—July 2010 Time Trends in Radiologists’ Interpretive Performance at Screening Mammography from the Community-based Breast Cancer Surveillance Consortium, 1996–2004 1 Laura E. Ichikawa, MS William E. Barlow, PhD Melissa L. Anderson, MS Stephen H. Taplin, MD, MPH Berta M. Geller, EdD R. James Brenner, MD, JD For the National Cancer Institute–sponsored Breast Cancer Surveillance Consortium Purpose: To examine time trends in radiologists’ interpretive per- formance at screening mammography between 1996 and 2004. Materials and Methods: All study procedures were institutional review board ap- proved and HIPAA compliant. Data were collected on sub- sequent screening mammograms obtained from 1996 to 2004 in women aged 40–79 years who were followed up for 1 year for breast cancer. Recall rate, sensitivity, and specificity were examined annually. Generalized estimating equation (GEE) and random-effects models were used to test for linear trend. The area under the receiver operating characteristic curve (AUC), tumor histologic findings, and size of the largest dimension or diameter of the tumor were also examined. Results: Data on 2 542 049 subsequent screening mammograms and 12 498 cancers diagnosed in the follow-up period were included in this study. Recall rate increased from 6.7% to 8.6%, sensitivity increased from 71.4% to 83.8%, and specificity decreased from 93.6% to 91.7%. In GEE models, adjusted odds ratios per calendar year were 1.04 (95% confidence interval [CI]: 1.02, 1.05) for recall rate, 1.09 (95% CI: 1.07. 1.12) for sensitivity, and 0.96 (95% CI: 0.95, 0.98) for specificity ( P , .001 for all). Random- effects model results were similar. The AUC increased over time: 0.869 (95% CI: 0.861, 0.877) for 1996–1998, 0.884 (95% CI: 0.879, 0.890) for 1999–2001, and 0.891 (95% CI: 0.885, 0.896) for 2002–2004 ( P , .001). Tumor histologic findings and size remained constant. Conclusion: Recall rate and sensitivity for screening mammograms in- creased, whereas specificity decreased from 1996 to 2004 among women with a prior mammogram. This trend re- mained after accounting for risk factors. The net effect was an improvement in overall discrimination, a measure of the probability that a mammogram with cancer in the follow-up period has a higher Breast Imaging Reporting and Data System assessment category than does a mam- mogram without cancer in the follow-up period. q RSNA, 2010 1 From the Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101 (L.E.I., W.E.B., M.L.A.); Cancer Research and Biostatistics, Seattle, Wash (W.E.B.); Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Md (S.H.T.); Health Promotion Research, Vermont Cancer Center, University of Vermont, Burlington, Vt (B.M.G.); Bay Imaging Consultants, Carol Ann Read Breast Health Center, Oakland, Calif (R.J.B.); and Department of Radiology, University of California, San Francisco, San Francisco, Calif (R.J.B.). Received October 8, 2009; revision requested No- vember 3; final revision received December 17; accepted January 11, 2010; final version accepted February 1. Address correspondence to L.E.I. (e-mail: ichikawa.l@ ghc.org). q RSNA, 2010