Margarita C Posso1,2, Teresa Puig3,4, Ma Jesus Quintana3,5, Judit Solà-Roca3, Xavier Bonfill3,4,5. 1. Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. mposso@cochrane.es. 2. Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret, 167. Pavelló 18, planta 0, CP: 08025, Barcelona, Spain. mposso@cochrane.es. 3. Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. 4. Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. 5. CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
Abstract
OBJECTIVES: To assess the costs and health-related outcomes of double versus single reading of digital mammograms in a breast cancer screening programme. METHODS: Based on data from 57,157 digital screening mammograms from women aged 50-69 years, we compared costs, false-positive results, positive predictive value and cancer detection rate using four reading strategies: double reading with and without consensus and arbitration, and single reading with first reader only and second reader only. Four highly trained radiologists read the mammograms. RESULTS: Double reading with consensus and arbitration was 15 % (Euro 334,341) more expensive than single reading with first reader only. False-positive results were more frequent at double reading with consensus and arbitration than at single reading with first reader only (4.5 % and 4.2 %, respectively; p < 0.001). The positive predictive value (9.3 % and 9.1 %; p = 0.812) and cancer detection rate were similar for both reading strategies (4.6 and 4.2 per 1000 screens; p = 0.283). CONCLUSIONS: Our results suggest that changing to single reading of mammograms could produce savings in breast cancer screening. Single reading could reduce the frequency of false-positive results without changing the cancer detection rate. These results are not conclusive and cannot be generalized to other contexts with less trained radiologists. KEY POINTS: • Double reading of digital mammograms is more expensive than single reading. • Compared to single reading, double reading yields a higher proportion of false-positive results. • The cancer detection rate was similar for double and single readings. • Single reading may be a cost-effective strategy in breast cancer screening programmes.
OBJECTIVES: To assess the costs and health-related outcomes of double versus single reading of digital mammograms in a breast cancer screening programme. METHODS: Based on data from 57,157 digital screening mammograms from women aged 50-69 years, we compared costs, false-positive results, positive predictive value and cancer detection rate using four reading strategies: double reading with and without consensus and arbitration, and single reading with first reader only and second reader only. Four highly trained radiologists read the mammograms. RESULTS: Double reading with consensus and arbitration was 15 % (Euro 334,341) more expensive than single reading with first reader only. False-positive results were more frequent at double reading with consensus and arbitration than at single reading with first reader only (4.5 % and 4.2 %, respectively; p < 0.001). The positive predictive value (9.3 % and 9.1 %; p = 0.812) and cancer detection rate were similar for both reading strategies (4.6 and 4.2 per 1000 screens; p = 0.283). CONCLUSIONS: Our results suggest that changing to single reading of mammograms could produce savings in breast cancer screening. Single reading could reduce the frequency of false-positive results without changing the cancer detection rate. These results are not conclusive and cannot be generalized to other contexts with less trained radiologists. KEY POINTS: • Double reading of digital mammograms is more expensive than single reading. • Compared to single reading, double reading yields a higher proportion of false-positive results. • The cancer detection rate was similar for double and single readings. • Single reading may be a cost-effective strategy in breast cancer screening programmes.
Entities:
Keywords:
Breast neoplasms; Costs and cost analysis; Early detection of cancer; Mammography; Mass screening
Authors: T Leivo; T Salminen; H Sintonen; R Tuominen; K Auerma; K Partanen; U Saari; M Hakama; O P Heinonen Journal: Breast Cancer Res Treat Date: 1999-04 Impact factor: 4.872
Authors: T M Ripping; A L M Verbeek; J Fracheboud; H J de Koning; N T van Ravesteyn; M J M Broeders Journal: Int J Cancer Date: 2015-02-05 Impact factor: 7.396
Authors: Stephen Taplin; Linn Abraham; William E Barlow; Joshua J Fenton; Eric A Berns; Patricia A Carney; Gary R Cutter; Edward A Sickles; D'Orsi Carl; Joann G Elmore Journal: J Natl Cancer Inst Date: 2008-06-10 Impact factor: 13.506
Authors: Angela M P Coolen; Joost R C Lameijer; Adri C Voogd; Marieke W J Louwman; Luc J Strobbe; Vivianne C G Tjan-Heijnen; Lucien E M Duijm Journal: Eur Radiol Date: 2018-06-25 Impact factor: 5.315
Authors: Boaz Karmazyn; Elise M Miller; Sara E Lay; James M Massey; Matthew R Wanner; Megan B Marine; S Gregory Jennings; Fangqian Ouyang; Roberta A Hibbard Journal: Pediatr Radiol Date: 2017-02-24
Authors: Sian Taylor-Phillips; David Jenkinson; Chris Stinton; Matthew G Wallis; Janet Dunn; Aileen Clarke Journal: Radiology Date: 2018-04-10 Impact factor: 11.105