Irish Journal of Medical Science (1971 -)

, Volume 188, Issue 1, pp 289–293 | Cite as

Breast cancers missed by screening radiologists can be detected by reading mammograms at a distance

  • Ineke L. Schreutelkamp
  • Robert M. Kwee
  • Peter Veekmans
  • Miraude E. A. P. M. AdriaensenEmail author
Original Article



During locally organized quality assurance evaluation sessions for screening radiologists, we noticed that individual screening radiologists did miss tumours which in our opinion could be detected at a distance.


To determine whether tumours missed by individual screening radiologists can be detected at a distance.


Twenty-eight screening mammograms of 28 females (mean age 63 years, range 49–73) with a pathologically proven malignant tumour missed by individual screening radiologists were mixed with 56 normal screening mammograms of 56 females (mean age 63 years, range 53–74). This test set was independently assessed by a senior screening radiologist and by a radiology resident without prior training in screening mammography at 1.5 m distance from the screen display. Readers were unaware of the prevalence of pathologically proven malignant tumours in the test set. Primary outcome was whether the reader would recall the woman.


The senior screening radiologist recalled 28 of 28 women with a pathologically proven malignant tumour (sensitivity of 100%) and 16 of 56 women without pathology (specificity of 71%). The radiology resident recalled 25 of 28 women with a pathologically proven malignant tumour (sensitivity of 89%) and 10 of 56 women without pathology (specificity of 82%).


Some malignant tumours missed by an individual screening radiologist can be detected from 1.5 m distance. Therefore, we recommend that screening radiologists consciously take a distant view before closely evaluating the mammogram in detail.


Breast cancer Detection Mammography Screening Test set 



The authors thank M.S.O. van Wissen, MD for reading the test set during her residency in radiology.

Compliance with ethical standards

Conflict of interest

Authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

In accordance with the national Data Protection Act, women were informed at screening that their data could be used anonymously for scientific research. Women can opt out, if they do not agree. The test set only consisted of screening mammograms of women who agreed to opt in.


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Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  • Ineke L. Schreutelkamp
    • 1
  • Robert M. Kwee
    • 2
  • Peter Veekmans
    • 3
  • Miraude E. A. P. M. Adriaensen
    • 2
    Email author
  1. 1.Bevolkingsonderzoek ZuidMaastricht-AirportThe Netherlands
  2. 2.Department of RadiologyZuyderland Medical CenterHeerlenThe Netherlands
  3. 3.Department of Medical ImagingSJG WeertWeertThe Netherlands

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