If you don't find it often, you often don't find it: why some cancers are missed in breast cancer screening.
If you don't find it often, you often don't find it: why some cancers are missed in breast cancer screening.
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DOI：
10.1371/journal.pone.0064366
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Wolfe JM
中科院分区：
文献类型：
--
作者：
Evans KK;Birdwell RL;Wolfe JM
乳房X光检查是早期发现乳腺癌的重要工具。然而，感知任务很困难，并且很大一部分癌症被遗漏。视觉搜索实验表明，当目标稀有（低患病率）时，漏检（假阴性）错误会增加，但尚不清楚低患病率是否是现实世界临床条件下的一个重要因素。在这里，我们表明，与在高患病率条件下寻找相同癌症时相比，在真实的、低患病率的临床环境中，专家级乳房X线照相技师漏掉的癌症比例要高得多。我们在九个月的时间里将 50 个阳性病例和 50 个阴性病例纳入城市医院乳腺癌筛查服务的正常工作流程中。这一速度足够慢，不足以显着提高放射科医生日常实践中的疾病患病率。六名放射科医生随后在一次会议中审查了所有 100 个病例，其中疾病患病率为 50%。在临床环境中，参与者漏掉了 30% 的癌症。在高患病率环境中，参与者仅漏掉了 12% 的相同癌症。在大多数情况下，这种低患病率效应可能是适应性的。通常明智的做法是对基本费率非常低的事件进行保守报道（那是飞碟吗？可能不是。）。然而，虽然这种对低流行率的反应似乎在人类视觉搜索机制中根深蒂固，但它可能不适用于医疗筛查等具有社会重要性的低流行率任务。虽然任何一项研究的结果都必须谨慎解释，但这些数据与这样的结论是一致的：这种对低患病率的行为反应可能是导致乳腺癌筛查失误的重要原因。
Mammography is an important tool in the early detection of breast cancer. However, the perceptual task is difficult and a significant proportion of cancers are missed. Visual search experiments show that miss (false negative) errors are elevated when targets are rare (low prevalence) but it is unknown if low prevalence is a significant factor under real world, clinical conditions. Here we show that expert mammographers in a real, low-prevalence, clinical setting, miss a much higher percentage of cancers than are missed when the mammographers search for the same cancers under high prevalence conditions. We inserted 50 positive and 50 negative cases into the normal workflow of the breast cancer screening service of an urban hospital over the course of nine months. This rate was slow enough not to markedly raise disease prevalence in the radiologists’ daily practice. Six radiologists subsequently reviewed all 100 cases in a session where the prevalence of disease was 50%. In the clinical setting, participants missed 30% of the cancers. In the high prevalence setting, participants missed just 12% of the same cancers. Under most circumstances, this low prevalence effect is probably adaptive. It is usually wise to be conservative about reporting events with very low base rates (Was that a flying saucer? Probably not.). However, while this response to low prevalence appears to be strongly engrained in human visual search mechanisms, it may not be as adaptive in socially important, low prevalence tasks like medical screening. While the results of any one study must be interpreted cautiously, these data are consistent with the conclusion that this behavioral response to low prevalence could be a substantial contributor to miss errors in breast cancer screening.
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影响因子：
19.7
作者：
Gur, D;Rockette, HE;Warfel, TE
通讯作者：
Warfel, TE
影响因子：
19.7
作者：
Pisano, Etta D.;Acharyya, Suddhasatta;Gatsonis, Constantine
通讯作者：
Gatsonis, Constantine
影响因子：
5
作者：
HARVEY, JA;FAJARDO, LL;INNIS, CA
通讯作者：
INNIS, CA
影响因子：
158.5
作者：
Pisano, ED;Gatsonis, C;Rebner, M
通讯作者：
Rebner, M
影响因子：
2.4
作者：
COLQUHOUN, WP
通讯作者：
COLQUHOUN, WP