European Radiology

, Volume 29, Issue 10, pp 5517–5527 | Cite as

Annual mammography at age 45–49 years and biennial mammography at age 50–69 years: comparing performance measures in an organised screening setting

  • Lauro BucchiEmail author
  • Alessandra Ravaioli
  • Flavia Baldacchini
  • Orietta Giuliani
  • Silvia Mancini
  • Rosa Vattiato
  • Fabio Falcini
  • Paolo Giorgi Rossi
  • Cinzia Campari
  • Debora Canuti
  • Enza Di Felice
  • Priscilla Sassoli de Bianchi
  • Stefano Ferretti
  • Nicoletta Bertozzi
  • on behalf of the Emilia-Romagna Region Workgroup for Mammography Screening Evaluation



To compare the results of 5 years of annual mammography screening at age 45–49 with the results of 5 years of biennial screening at age 50–54 and 55–69.


In an Italian screening programme, data from 1,465,335 mammograms were analysed. Recall rates, invasive assessment rates, surgical biopsy (including excisional biopsy and definitive surgical treatment) rates, and cancer detection rates were calculated for the first screen (first) and, cumulatively, for the second and subsequent screens (second+).


The rate ratios between younger women and the two groups of older ones were (in parentheses, original figures per 1000 mammograms if not otherwise specified): recall rate: first 1.11 (103.6 vs. 93.5) and 1.11 (vs. 93.2), second+ 2.10 (208.9 vs. 99.7) and 2.77 (vs. 75.5); invasive assessment rate: first 0.94 (23.0 vs. 24.5) and 0.94 (vs. 24.6), second+ 1.63 (35.8 vs. 22.0) and 1.56 (vs. 23.0); surgical biopsy rate: first 0.68 (5.9 vs. 8.6) and 0.45 (vs. 13.2), second+ 1.35 (11.5 vs. 8.5) and 0.88 (vs. 13.0); total detection rate: first 0.63 (4.3 vs. 6.7) and 0.37 (vs. 11.7), second+ 1.30 (8.9 vs. 6.8) and 0.74 (vs. 12.0); total positive predictive value of surgical biopsy: first 0.93 (72.8% vs. 78.0%) and 0.82 (vs. 88.9%), second+ 0.96 (77.2% vs. 80.5%) and 0.83 (vs. 92.7%).


Younger women experienced two to threefold higher cumulative recall rates at second+ screens and limited differences in surgical biopsy rate. Albeit encouraging, these results must be completed with further investigation, especially on interval cancer incidence.

Key Points

• At repeated screens, cumulative recall rate was two- to threefold higher for younger women.

• Differences in cumulative surgical referral and surgical biopsy rates were moderate.

• Differences in positive predictive value of surgical biopsy were particularly small.


Mass screening Mammography Breast neoplasms Premenopause Biopsy 



Ductal carcinoma in situ


European Commission Initiative on Breast Cancer


Fine-needle aspiration


Italian Group for Mammography Screening


Needle core biopsy


Positive predictive value


Vacuum-assisted biopsy



The membership of the Emilia-Romagna Region Workgroup for Mammography Screening Evaluation is as follows: Stefano Ferretti (University of Ferrara and Local Health Authority, Ferrara, Italy); Nicoletta Bertozzi, Enza Di Felice, Alba Carola Finarelli, Carlo Naldoni, Priscilla Sassoli de Bianchi (Department of Health, Regional Administration, Emilia-Romagna Region, Bologna, Italy); Flavia Baldacchini, Lauro Bucchi, Orietta Giuliani, Silvia Mancini, Alessandra Ravaioli, Rosa Vattiato (Romagna Cancer Institute, IRST, IRCCS, Meldola, Forlì, Italy); Fabio Falcini (Romagna Cancer Institute, IRST, IRCCS, Meldola, Forlì, and Local Health Authority, Forlì, Italy); Elisabetta Borciani, Giorgio Celoni, Giorgio Gatti, Rosella Schianchi (Local Health Authority, Piacenza, Italy); Nicoletta Piazza, Marella Zatelli (Local Health Authority, Parma, Italy); Paolo Giorgi Rossi (Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy); Cinzia Campari, Antonella Cattani, Luisa Paterlini (Cancer Screening Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy); Carlo Alberto Mori, Rita Vacondio (Cancer Screening Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Reggio Emilia, Italy); Valeria Bellelli, Giuliano Carrozzi, Rossella Corradini, Claudia Mauri, Rossella Negri (Local Health Authority, Modena, Italy); Carmen Bazzani, Marilena Manfredi, Francesca Mezzetti, Adriana Pasquini, Gianni Saguatti (Local Health Authority, Bologna, Italy); Licia Caprara, Stefania Cortecchia, Margherita De Lillo, Roberto Nannini (Local Health Authority, Imola, Italy); Giorgio Benea, Aldo De Togni, Caterina Palmonari, Roberto Pasqualini (Local Health Authority, Ferrara, Italy); Patrizia Bravetti, Monica Serafini, Benedetta Vitali (Local Health Authority, Ravenna, Italy); Antonella Bagni, Claudia Imolesi, Mauro Palazzi (Local Health Authority, Cesena, Italy); Debora Canuti, Lorenzo Menghini, Giancarla Monticelli (Local Health Authority, Rimini, Italy).


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Lauro Bucchi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Three of the authors have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because of its retrospective nature.

Ethical approval

Institutional Ethics Committee approval was obtained (ID: IRST 100.37).


• retrospective

• observational

• multicentre study

Supplementary material

330_2019_6050_MOESM1_ESM.docx (305 kb)
ESM 1 (DOCX 305 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Lauro Bucchi
    • 1
    Email author
  • Alessandra Ravaioli
    • 1
  • Flavia Baldacchini
    • 1
  • Orietta Giuliani
    • 1
  • Silvia Mancini
    • 1
  • Rosa Vattiato
    • 1
  • Fabio Falcini
    • 1
    • 2
  • Paolo Giorgi Rossi
    • 3
  • Cinzia Campari
    • 4
  • Debora Canuti
    • 5
  • Enza Di Felice
    • 6
  • Priscilla Sassoli de Bianchi
    • 6
  • Stefano Ferretti
    • 7
  • Nicoletta Bertozzi
    • 6
  • on behalf of the Emilia-Romagna Region Workgroup for Mammography Screening Evaluation
  1. 1.Romagna Cancer RegistryRomagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS)ForlìItaly
  2. 2.Local Health AuthorityForlìItaly
  3. 3.Epidemiology UnitAzienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
  4. 4.Cancer Screening UnitAzienda Unità Sanitaria Locale – IRCCS di Reggio EmiliaReggio EmiliaItaly
  5. 5.Local Health AuthorityRiminiItaly
  6. 6.Department of HealthRegional Administration, Emilia-Romagna RegionBolognaItaly
  7. 7.University of Ferrara and Local Health AuthorityFerraraItaly

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