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Optimum screening mammography reading volumes: evidence from the NHS Breast Screening Programme

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Abstract

Objectives

Minimum caseload standards for professionals examining breast screening mammograms vary from 480 (US) to 5000 (Europe). We measured the relationship between the number of women’s mammograms examined per year and reader performance.

Methods

We extracted routine records from the English NHS Breast Screening Programme for readers examining between 1000 and 45,000 mammograms between April 2014 and March 2017. We measured the relationship between the volume of cases read and screening performance (cancer detection rate, recall rate, positive predictive value of recall (PPV) and discrepant cancers) using linear logistic regression. We also examined the effect of reader occupational group on performance.

Results

In total, 759 eligible mammography readers (445 consultant radiologists, 235 radiography advanced practitioners, 79 consultant radiographers) examined 6.1 million women’s mammograms during the study period. PPV increased from 12.9 to 14.4 to 17.0% for readers examining 2000, 5000 and 10000 cases per year respectively. This was driven by decreases in recall rates from 5.8 to 5.3 to 4.5 with increasing volume read, and no change in cancer detection rate (from 7.6 to 7.6 to 7.7). There was no difference in cancer detection rate with reader occupational group. Consultant radiographers had higher recall rate and lower PPV compared to radiologists (OR 1.105, p = 0.012; OR 0.874, p = 0.002, unadjusted).

Conclusion

Positive predictive value of screening increases with the total volume of cases examined per reader, through decreases in numbers of cases recalled with no concurrent change in numbers of cancers detected.

Key Points

• In the English Breast Screening Programme, readers who examined a larger number of cases per year had a higher positive predictive value, because they recalled fewer women for further tests but detected the same number of cancers.

• Reader type did not affect cancer detection rate, but consultant radiographers had a higher recall rate and lower positive predictive value than consultant radiologists, although this was not adjusted for length of experience.

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Abbreviations

BSIS:

Breast Screening Information System

CDR:

Cancer detection rate

IQR:

Inter quartile range

KC62:

National Health Service Breast Screening Programme Central Return Data Set

NHSBSP:

National Health Service Breast Screening Programme

OR:

Odds ratio

PPV:

Positive predictive value

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Acknowledgements

The authors acknowledge Public Health England.

Funding

The analysis for this study was undertaken by Public Health England staff as part of the quality assurance function of the NHS Breast Screening Programme. STP is funded by the NIHR through a career development fellowship (NIHR-CDF-2016-09-018). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Author information

Authors and Affiliations

  1. Thirlestaine Breast Unit, Cobalt House, Gloucestershire Hospitals NHS Foundation Trust, Thirlestaine Road, Cheltenham, Gloucestershire, GL53 7AS, UK

    Eleanor Cornford

  2. Public Health England, 5 St Philips Place, Birmingham, B3 2PW, UK

    Shan Cheung

  3. Screening QA Service (South) Public Health England, Birmingham, UK

    Mike Press

  4. National Lead Breast Screening Research & Data, Screening Division, Public Health England, Birmingham, UK

    Olive Kearins

  5. Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7A, UK

    Sian Taylor-Phillips

Authors
  1. Eleanor Cornford
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  2. Shan Cheung
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  3. Mike Press
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  4. Olive Kearins
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  5. Sian Taylor-Phillips
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Corresponding author

Correspondence to Eleanor Cornford.

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Guarantor

The scientific guarantor of this publication is Eleanor Cornford

Conflict of interest

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.

Statistics and biometry

Shan Cheung and Sian Taylor-Phillips kindly provided statistical advice for this manuscript. Both of these authors have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because this analysis of de-identified data is classified as audit as part of the quality assurance function of the breast screening programme by Public Health England

Ethical approval

Institutional Review Board approval was not required because this analysis of de-identified data is classified as an audit as part of the quality assurance function of the breast screening programme by Public Health England and therefore did not require ethical committee review.

Methodology

• prospective

• observational

• national

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Cornford, E., Cheung, S., Press, M. et al. Optimum screening mammography reading volumes: evidence from the NHS Breast Screening Programme. Eur Radiol 31, 6909–6915 (2021). https://doi.org/10.1007/s00330-021-07754-8

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  • DOI: https://doi.org/10.1007/s00330-021-07754-8

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