The Vermont Breast Cancer Surveillance System (BVCSS) proposes to continue membership in the Breast Cancer Surveillance Consortium (BCSC). As the most rural state in the nation, Vermont is well suited to complement more urban sites currently represented in the NCI Consortium. Our goal is to have our Vermont multi- disciplinary team of researchers join with other investigators at other BCSC sites and the NCI staff to conduct collaborative breast cancer surveillance research. Our aims for the core proposal are: a) to maintain and improve a comprehensive, quality controlled, statewide surveillance system that accesses existing records and collects new information from mammography facilities, pathology laboratories, and a population-based cancer registry; b) to continue and expand breast cancer research collaborations and interactions among basic science researchers, clinical researchers and applied researchers in Vermont and in the NCI Breast Cancer Surveillance Consortium; c) to examine the operational aspects of breast cancer screening and diagnosis by conducting systematic research designed to assess the effectiveness and efficiency of screening programs and diagnostic techniques as they relate to the improvement of stage at diagnosis and breast cancer mortality. The two special research projects are focused on the use of additional imaging beyond the standard four-view screening mammogram. In project 1 we will determine the diagnostic accuracy of using either additional mammographic views and/or ultrasound compared with the standard four-view mammogram. In project 2 we will establish the psychological, social and behavioral effects of being recalled for additional imaging.