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.
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Abbreviations
- DCIS:
-
Ductal carcinoma in situ.
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Acknowledgements
The scientific guarantor of this publication is Margarita C. Posso Rivera. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, cross sectional study, performed at one institution.
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Margarita C. Posso is a Ph.D. candidate at the Methodology of Biomedical Research and Public Health program Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Posso, M.C., Puig, T., Quintana, M.J. et al. Double versus single reading of mammograms in a breast cancer screening programme: a cost-consequence analysis. Eur Radiol 26, 3262–3271 (2016). https://doi.org/10.1007/s00330-015-4175-4
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DOI: https://doi.org/10.1007/s00330-015-4175-4