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  • br methods This is only justified because the


    methods. This is only justified because the proportion of cancers from open biopsy is very small. A further limitation of the study is the lack of detailed information on size, grade, and nodal status of invasive cancers detected at different biopsy rates.
    Any changes to the national programme by setting bi-opsy rate targets would require careful monitoring to ensure no detrimental effects to the screening programme were occurring. Particular attention needs to be taken to ensure any 158021-47-7 in biopsy rates does not affect detec-tion rates of small higher-grade invasive cancers. By setting recall rate targets, biopsy rates may be affected and vice-versa. It is therefore probably not advisable to introduce both recall rate and biopsy rates targets or changes in tar-gets at the same time. Any changes to either recall rates or biopsy rates would require close monitoring.
    In summary, over the last quarter of a century or more the English NHSBSP has been more focussed on improving sensitivity than specificity. Recall rates higher than targets have tended to be tolerated in preference to low invasive cancer detection rates. This study demonstrates that high recall rates are associated with high biopsy rates and high non-malignant/benign biopsy rates, which contribute to the harms of screening.
    Conflicts of interest
    The authors declare no conflict of interest
    R.G.B. and R.A. are funded by Public Health England. The work arose from initial discussions at the Clinical Advisory Group for NHSBSP assessment work (members R.G.B., Claire Borrelli, Sue Cohen, Alison Duncan, R.G.-W., J.J., Olive Kearins, Sarah Pinder, Mark Sibbering, Nisha Sharma, Jim Steel, Anne Turnbull, M.G.W.).
    Appendix A. Supplementary data
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