Additional Mammogram Readers Improve Breast Cancer Detection

Studies have shown that breast cancer detection may increase when mammograms are reviewed by both a radiologist and a mammographic technologist. In The Netherlands, a breast cancer screening program was implemented in the 1990s that required all mammograms be read by two radiologists. Mammographic technologists were also trained to look for abnormalities.

Lucien Duijm, M.D., Ph.D., of Catharina Hospital in Eindhoven, The Netherlands, and colleagues examined whether adding readings by two technologists to the standard examination by two radiologists would improve cancer detection rates and the accuracy of the readings.

The breast cancer detection rate increased 6.8% (from 5.27 to 5.63 cancers per 1,000 women screened) when the mammograms were read by two technologists and two radiologists. And adding two technologists only slightly increased the number of false positives, compared with readings by a pair of radiologists alone.

"Our results indicate that all technologist-positive readings should be considered for [further] examination because this subset of screening mammograms shows a high prevalence of breast cancer," the authors write.

In an accompanying editorial, Joann Elmore, M.D., of Harborview Medical Center in Seattle and James Brenner, M.D., J.D., of the University of California, San Francisco discuss the challenges of generalizing the results of the study because of differences in screening programs around the world.

"Ultimately, deciding on the number of readers needed to interpret a screening mammogram will depend on how many readers are available and which outcomes we seek," the authors write.

Citations:

Article: Duijm LEM, Groenewoud JH, Fracheboud J, De Koning HJ. Additional Double Reading of Screening Mammograms by Radiologic Technologists: Impact on Screening Performance Parameters. J Natl Cancer Inst 2007; 1162-1170

Editorial: Elmore JG, Brenner RJ. The More Eyes, the Better to See" From Double to Quadruple Reading of Screening Mammograms. J Natl Cancer Inst 2007; 99: 1141-1143