Second reading of screening mammograms increases cancer detection and recall rates. Results in the Florence screening programme

Objective: To assess double reading effectiveness in mammography screening. Design: Retrospective study of 177,631 consecutive mammograms double read during 1998–2003. Setting: The Florence screening programme, involving 11 trained radiologists. Abnormalities reported by at least one reader prompted...

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Bibliographic Details
Published in:Journal of medical screening 2005-01, Vol.12 (2), p.103-106
Main Authors: Ciatto, S, Ambrogetti, D, Bonardi, R, Catarzi, S, Risso, G, Rosselli Del Turco, M, Mantellini, P
Format: Article
Language:English
Subjects:
Aged
Breast Neoplasms - diagnosis
Cost-Benefit Analysis
Costs and Cost Analysis
Diagnostic Errors
Female
Humans
Italy
Mammography - methods
Mass Screening - methods
Middle Aged
Observer Variation
Reproducibility of Results
Retrospective Studies
X-Ray Film
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Summary:Objective: To assess double reading effectiveness in mammography screening. Design: Retrospective study of 177,631 consecutive mammograms double read during 1998–2003. Setting: The Florence screening programme, involving 11 trained radiologists. Abnormalities reported by at least one reader prompted assessment. Results: The referral rate was 2.89% for the first reader, 3.15% for the second reader, and 3.59% for either reader. Of 713 total cancers detected, 43 were suspected only by the second reader (6.4% relative, 0.024% increase in absolute detection rate) and had a lower stage compared to the first reader (pTis–pT1b = 65.7 versus 52.0%): 41 were reviewed and classified (error type) as 'minimal sign' in six, and 'screening error' in 35 cases, or as BI-RADS 3 in one, 4a in 20, 4b in 13, and 4c in three cases. The second reading cost was €2.70 per woman examined, or €11,168 per additional cancer detected (versus €11,585 at a single reading). Discussion: Second reading is effective in detecting a limited number of additional cancer cases. Tumour stage (one-third over 1 cm in diameter) and review findings (high rate of 'screening errors' and BI-RADS R4b-c categories) suggest that second reading detects small 'difficult cases' as well as larger cancers missed due to fatigue or loss of attention. Second reading reduces screening specificity to a minor extent, and since cancer detection at second reading seems cost-effective the procedure is recommendable in routine practice.
ISSN:0969-1413
1475-5793
DOI:10.1258/0969141053908285