Skip to content


  • Oral presentation
  • Open Access

Are abnormalities missed in the PERFORMS self-assessment scheme due to visual or cognitive factors?

  • 1,
  • 1 and
  • 1
Breast Cancer Research201416 (Suppl 1) :O5

  • Published:


  • Error Rate
  • Cancer Detection
  • Perform Test
  • Difficult Case
  • Cognitive Factor


To examine whether missed abnormalities in PERFORMS test sets are mainly due to visual or cognitive factors.


Data were examined from three recent rounds of the PERFORMS breast screening self-assessment scheme (that is, three sets of 120 difficult normal, benign and malignant FFDM cases) that had respectively been reported by 723, 726 and 687 breast radiologists and advanced practitioners in order to determine the error rates and the underlying reasons for such errors. Every participant had read each case set in a different random order.


The cancer detection in the three rounds was high, with mean values of 82%, 86% and 93%. However, in terms of discrepant recall decisions between individuals and overall decisions, there were both over-reading (for the normal and benign cases) and under-reading errors (for the malignant cases) for many cases; although there was no statistical difference in the error rate between these three case categories. Overall, for the normal cases there were 15.55% false positives, with the majority of these being scored as indeterminate (13.37%). For malignant cases there were 16% false negatives, with 11.45% reported normal and 4.12% benign. Further analyses demonstrated that the majority of the false negative errors were due to mammographic features being missed (unseen) rather than being seen but then misinterpreted - a cognitive error (t test, P < 0.002).


In examining these difficult case sets from the PERFORMS scheme, most errors were due to key abnormal mammographic features not being seen.

Authors’ Affiliations

Loughborough University, Loughborough, UK


© Chen et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.