Is Maximum Positive Predictive Value a Good Indicator of an Optimal Screening Mammography Practice?

Positive predictive value (PPV1) has been used as one important indicator of the quality of screening mammography programs. We show how the relationship between sensitivity and recall rate may affect the operating point at which optimal (maximum) PPV1 occurs. Optimal (maximum) PPV1 can occur at any sensitivity level and should not be used as the sole indicator for practice optimization because it does not take into account the number of cancers that would be missed at that sensitivity.