A comparison of cancer detection rates achieved by breast cancer screening programmes by number of readers, for one and two view mammography: results from the UK National Health Service breast screening programme

J Med Screen 1998;5:195-201
doi:10.1136/jms.5.4.195
© 1998 Medical Screening Society

 

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Original Papers


R G Blanks,
M G Wallis and
S M Moss
,


Cancer Screening Evaluation Unit, Institute of Cancer Research, Section of Epidemiology, D Block, Cotswold Road, Sutton, Surrey SM2 5NG, UK;
Breast Screening Unit, Coventry and Warwick Hospital, Stoney Stanton Road, Coventry CV1 4FH, UK;
Cancer Screening Evaluation Unit, Institute of Cancer Research, Section of Epidemiology, D Block, Cotswold Road, Sutton, Surrey SM2 5NG, UK


Objective To determine the increased cancer detection rate,if any, of programmes in the UK National Health Service breastscreening programme (NHSBSP) using more than single readingof mammograms.

Design Information on the detection of cancers by individualscreening programmes from annual (KC62) returns, supplementedby questionnaire information about the number of readers.

Setting The 87 NHSBSP programmes from England and Wales for the screening year 1 April 1996 to 31 March 1997. The study includes all programmes for prevalent screens where two views are mandatory, but excludes the four programmes using two view mammography for incident screening. Main outcome measuresCancerdetection, invasive cancer detection, and small (<15 mm)invasive cancer detection by mammographic reading protocol usingsingle reading as the reference level.

Results Programmes collectively using single reading detectedthe lowest rate of cancers at both prevalent (first) and incident(subsequent) screening. The highest rate of age standardisedcancer detection was achieved by programmes using double readingwith arbitration. At prevalent screens, where all programmesused two views, those programmes using double reading with arbitrationdetected 32% (95% confidence interval (CI) 3% to 69%) more small(<15 mm) invasive cancers than programmes using single reading.At incident screens, where all programmes analysed used oneview this increased to 73% (95% CI 40% to 113%). Recall ratesshowed no obvious difference between single reading and thedouble reading protocols, being around 7% for prevalent screensand 3.5% for incident screens.

Discussion The results suggest that the increase in cancer detectionresulting from increasing the number of readers depends on thenumber of views, and is higher for one view than two views.Single reading of one view results in a low detection rate ofsmall invasive cancers for most individual programmes. It is,however, recognised that a small number of individual readersmay achieve high detection rates with such a protocol. All groupsof programmes using different reader/view protocols are on averageclose to or above target cancer detection rates, except thoseusing single reading of one view (mediolateral oblique) at incidentscreens.


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