Breast cancer screening in a multimodality environment--the need for a simple summary measure of marginal value

In a rapidly changing clinical environment, assessment of imaging-based technologies and practices for periodic screening for the early detection of breast cancer is constrained by cost, complexity, and professional resources, particularly concerning supplementary imaging of subgroups constituting a large fraction of the screened population. Relatively high survival rates after detection make it extremely difficult to adequately assess marginal values of proposed approaches either before the technology in question being widely accepted and used or before it becomes largely obsolete. The author discusses several issues related to the assessment process and proposes the use of a surrogate summary measure of performance for this purpose, namely the number of recalled cases for the diagnostic workup of suspicious findings during repeat examinations, per one additional screen detected cancer that is invasive, node-negative, and classified grade 2 or above.