The Impact of Radiologist Screening Mammogram Reading Volume on Performance in the Ontario Breast Screening Program

Purpose: Although some studies have shown increasing radiologists’ mammography volumes improves performance, there is a lack of evidence specific to digital mammography and breast screening program performance targets. This study evaluates the relationship between digital screening volume and meeting performance targets. Methods: This retrospective cohort study included 493 radiologists in the Ontario Breast Screening Program who interpreted 1,762,173 screening mammograms in participants ages 50-90 between 2014 and 2016. Associations between annual screening volume and meeting performance targets for abnormal call rate, positive predictive value (PPV), invasive cancer detection rate (CDR), sensitivity, and specificity were modeled using mixed-effects multivariate logistic regression. Results: Most radiologists read 500-999 (36.7%) or 1,000-1,999 (31.0%) screens annually, and 18.5% read ≥2,000. Radiologists who read ≥2,000 annually were more likely to meet abnormal call rate (OR = 3.85; 95% CI: 1.17-12.61), PPV (OR = 5.36; 95% CI: 2.53-11.34), invasive CDR (OR = 4.14; 95% CI: 1.50-11.46), and specificity (OR = 4.07; 95% CI: 1.89-8.79) targets versus those who read 100-499 screens. Radiologists reading 1,000-1,999 screens annually were more likely to meet PPV (OR = 2.32; 95% CI: 1.22-4.40), invasive CDR (OR = 3.36; 95% CI: 1.49-7.59) and specificity (OR = 2.00; 95% CI: 1.04-3.84) targets versus those who read 100-499 screens. No significant differences were observed for sensitivity. Conclusions: Annual reading volume requirements of 1,000 in Canada are supported as screening volume above 1,000 was strongly associated with achieving performance targets for nearly all measures. Increasing the minimum volume to 2,000 may further reduce the potential limitations of screening due to false positives, leading to improvements in overall breast screening program quality.

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Standardized Abnormal Interpretation and Cancer Detection Ratios to Assess Reading Volume and Reader Performance in a Breast Screening Program

Radiology ◽

10.1148/radiology.215.2.r00ma42563 ◽

2000 ◽

Vol 215 (2) ◽

pp. 563-567 ◽

Cited By ~ 79

Author(s):

Lisa Kan ◽

Ivo A. Olivotto ◽

Linda J. Warren Burhenne ◽

Edward A. Sickles ◽

Andrew J. Coldman

Keyword(s):

Cancer Detection ◽

Breast Screening ◽

Screening Program ◽

Reading Volume

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278 POSTER Assessing the impact of the NHS breast screening program

European Journal of Surgical Oncology ◽

10.1016/s0748-7983(06)70713-2 ◽

2006 ◽

Vol 32 ◽

pp. S83

Author(s):

H.J. Cain ◽

S. Amonka ◽

L. Jalini ◽

K. Clark ◽

W. Cunliff ◽

...

Keyword(s):

Breast Screening ◽

Screening Program ◽

The Impact

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Performance Measures of Magnetic Resonance Imaging Plus Mammography in the High Risk Ontario Breast Screening Program

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz079 ◽

2019 ◽

Vol 112 (2) ◽

pp. 136-144 ◽

Cited By ~ 11

Author(s):

Anna M Chiarelli ◽

Kristina M Blackmore ◽

Derek Muradali ◽

Susan J Done ◽

Vicky Majpruz ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

High Risk ◽

Magnetic Resonance ◽

Cancer Detection ◽

Breast Screening ◽

Screening Program ◽

Breast Cancers ◽

Resonance Imaging ◽

High Risk Women ◽

Mutation Carriers

Abstract Background The Ontario Breast Screening Program expanded in July 2011 to screen high-risk women age 30–69 years with annual magnetic resonance imaging (MRI) and digital mammography. This study examined the benefits of screening with mammography and MRI by age and risk criteria. Methods This prospective cohort study included 8782 women age 30–69 years referred to the High Risk Ontario Breast Screening Program from July 2011 to June 2015, with final results to December 2016. Cancer detection rates, sensitivity, and specificity of MRI and mammography combined were compared with each modality individually within risk groups stratified by age using generalized estimating equation models. Prognostic features of screen-detected breast cancers were compared by modality using Fisher exact test. All P values are two-sided. Results Among 20 053 screening episodes, there were 280 screen-detected breast cancers (cancer detection rate = 14.0 per 1000, 95% confidence interval [CI] = 12.4 to 15.7). The sensitivity of mammography was statistically significantly lower than that of MRI plus mammography (40.8%, 95% CI = 29.3% to 53.5% vs 96.0%, 95% CI = 92.2% to 98.0%, P < .001). In mutation carriers age 30–39 years, sensitivity of the combination was comparable with MRI alone (100.0% vs 96.8%, 95% CI = 79.2% to 100.0%, P = .99) but with statistically significantly decreased specificity (78.0%, 95% CI = 74.7% to 80.9% vs 86.2%, 95% CI = 83.5% to 88.5%, P < .001). In women age 50–69 years, combining MRI and mammography statistically significantly increased sensitivity compared with MRI alone (96.3%, 95% CI = 90.6% to 98.6% vs 90.9%, 95% CI = 83.6% to 95.1%, P = .02), with a small but statistically significant decrease in specificity (84.2%, 95% CI = 83.1% to 85.2% vs 90.0%, 95% CI = 89.2% to 90.9%, P < .001). Conclusions Screening high risk women age 30–39 years with annual MRI only may be sufficient for cancer detection and should be evaluated further, particularly for mutation carriers. Among women age 50–69 years, detection is most effective when mammography is included with annual MRI.

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False-positive Screening Mammograms and Biopsies Among Women Participating in a Canadian Provincial Breast Screening Program

Can J Public Health ◽

10.1007/bf03405630 ◽

2012 ◽

Vol 103 (6) ◽

pp. e420-e424 ◽

Cited By ~ 6

Author(s):

Andrew J. Coldman ◽

Norman Phillips

Keyword(s):

False Positive ◽

Breast Screening ◽

Screening Program ◽

Screening Mammograms

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The Relationship between Mammography Readers’ Real-Life Performance and Performance in a Test Set–based Assessment Scheme in a National Breast Screening Program

Radiology: Imaging Cancer ◽

10.1148/rycan.2020200016 ◽

2020 ◽

Vol 2 (5) ◽

pp. e200016

Author(s):

Yan Chen ◽

Jonathan J. James ◽

Eleanor J. Cornford ◽

Jacquie Jenkins

Keyword(s):

Breast Screening ◽

Screening Program ◽

Real Life ◽

Test Set ◽

National Breast ◽

And Performance ◽

The Relationship

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Optimising breast cancer screening reading: blinding the second reader to the first reader’s decisions

European Radiology ◽

10.1007/s00330-021-07965-z ◽

2021 ◽

Author(s):

Jennifer A. Cooper ◽

David Jenkinson ◽

Chris Stinton ◽

Matthew G. Wallis ◽

Sue Hudson ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Positive Predictive Value ◽

Breast Cancer Screening ◽

Cancer Detection ◽

Predictive Value ◽

Breast Screening ◽

Multilevel Models ◽

Credible Interval ◽

Screening Mammograms

Abstract Objectives In breast cancer screening, two readers separately examine each woman’s mammograms for signs of cancer. We examined whether preventing the two readers from seeing each other’s decisions (blinding) affects behaviour and outcomes. Methods This cohort study used data from the CO-OPS breast-screening trial (1,119,191 women from 43 screening centres in England) where all discrepant readings were arbitrated. Multilevel models were fitted using Markov chain Monte Carlo to measure whether reader 2 conformed to the decisions of reader 1 when they were not blinded, and the effect of blinding on overall rates of recall for further tests and cancer detection. Differences in positive predictive value (PPV) were assessed using Pearson’s chi-squared test. Results When reader 1 recalls, the probability of reader 2 also recalling was higher when not blinded than when blinded, suggesting readers may be influenced by the other’s decision. Overall, women were less likely to be recalled when reader 2 was blinded (OR 0.923; 95% credible interval 0.864, 0.986), with no clear pattern in cancer detection rate (OR 1.029; 95% credible interval 0.970, 1.089; Bayesian p value 0.832). PPV was 22.1% for blinded versus 20.6% for not blinded (p < 0.001). Conclusions Our results suggest that when not blinded, reader 2 is influenced by reader 1’s decisions to recall (alliterative bias) which would result in bypassing arbitration and negate some of the benefits of double-reading. We found a relationship between blinding the second reader and slightly higher PPV of breast cancer screening, although this analysis may be confounded by other centre characteristics. Key Points • In Europe, it is recommended that breast screening mammograms are analysed by two readers but there is little evidence on the effect of ‘blinding’ the readers so they cannot see each other’s decisions. • We found evidence that when the second reader is not blinded, they are more likely to agree with a recall decision from the first reader and less likely to make an independent judgement (alliterative error). This may reduce overall accuracy through bypassing arbitration. • This observational study suggests an association between blinding the second reader and higher positive predictive value of screening, but this may be confounded by centre characteristics.

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Results from the Ontario breast screening program, 1990–1995

Journal of Medical Screening ◽

10.1136/jms.5.2.73 ◽

1998 ◽

Vol 5 (2) ◽

pp. 73-80 ◽

Cited By ~ 21

Author(s):

A R Libstug ◽

V Moravan ◽

S E Aitken

Keyword(s):

Cancer Detection ◽

Breast Screening ◽

Screening Programme ◽

Screening Program ◽

Tumour Size ◽

Clinical Breast Examination ◽

Nodal Status ◽

Detection Rates ◽

Intermediate Outcomes ◽

Clinical Breast

Objective The Ontario breast screening program (OBSP) is a provincial breast screening programme offering two view mammography, clinical breast examination, instruction in breast self examination, and systematic two year recall to Ontario women 50 years and older. This paper presents the results of the programme's intermediate outcomes from 1990 to 1995 and compares them with recommended standards and other published programmes. Methods Programme data from a provincial screening programme in a large Canadian province were collated from 18 sites in operation between July 1990 and December 1995. Results In its first five years of operation, 215 738 screens were performed on 142 173 women. The referral rates for initial and rescreens are 13.8% and 8.6% respectively. A total of 1718 women were diagnosed with cancer, 1325 at initial screens and 393 at rescreens, resulting in cancer detection rates of 9.3 and 5.3/1000. The cancer detection rates for invasive cancers were 8.3/1000 at initial screens and 4.5/1000 at rescreens. The benign to malignant biopsy ratio was 1.5:1 at initial screens and 1.3:1 at rescreens. Of the 1358 cancers diagnosed at initial screens, 11.6% were in situ and 50.3% of invasive cancers of known size were <15 mm. For women with invasive cancer where nodal status was known, 71.3% were node negative. The proportions at rescreens were 15.7%, 60.0%, and 76.0% respectively. Conclusions While the OBSP has achieved the standards suggested by other studies and programmes during its first five years of operation, there is work to be done to increase participation and obtain more complete data on tumour size and nodal status.

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