Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

In mammography screening with double reading, different strategies can be used when the readers give discordant recommendations for referral. We investigated whether the results of the Dutch breast cancer screening programme can be optimised by replacing the standard referral strategy by consensus. Twenty-six screening radiologists independently and blinded to outcome read a test set consisting of previous screening mammograms of 250 cases (screen-detected and interval cancers) and 250 controls. Their referral recommendations were paired and, in case of discrepancy, re-read according to three referral strategies: (1) decision by one of the readers; (2) arbitration by a third reader; (3) referral if both readers agree (consensus). Data allowed studying other referral strategies, including referral if any reader suggests, as well. Double reading with referral if any reader suggests resulted in a 1.03 times higher sensitivity (76.6%) and a 1.31 times higher referral rate (1.26%) than double reading with consensus. To estimate the cost-effectiveness, the outcomes were used in a microsimulation model. Even if double reading with referral if any reader suggests results in four times as high referral rates and an accompanying increase of biopsies or other invasive procedures, the cost-effectiveness of €4,190 per life-year gained may well be in the range of acceptable cost-effectiveness for Dutch health care programmes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fracheboud J, de Koning HJ, Boer R, Groenewoud JH, Verbeek AL, Broeders MJ, van Ineveld BM, Hendriks JH, de Bruyn AE, Holland R, van der Maas PJ (2001) Nationwide breast cancer screening programme fully implemented in The Netherlands. Breast 10(1):6–11

    Article  PubMed  CAS  Google Scholar 

  2. Duijm LE, Groenewoud JH, Hendriks JH, de Koning HJ (2004) Independent double reading of screening mammograms in The Netherlands: effect of arbitration following reader disagreements. Radiology 231(2):564–570

    PubMed  Google Scholar 

  3. Uitspraak Medisch Tuchtcollege ‘s-Gravenhage (1998) Verdict Medical Disciplinary Board ‘s-Gravenhage [in Dutch]. Med Contact 53:661–662

    Google Scholar 

  4. Uitspraak Medisch Tuchtcollege ‘s-Gravenhage (1998) Verdict Medical Disciplinary Board ‘s-Gravenhage [in Dutch]. Staatscourant 20–21

  5. Boer R, de Koning H, van Oortmarssen G, Warmerdam P, van der Maas P (1999) Stage distribution at first and repeat examinations in breast cancer screening. J Med Screen 6(3):132–138

    PubMed  CAS  Google Scholar 

  6. Otten JD, Karssemeijer N, Hendriks JH, Groenewoud JH, Fracheboud J, Verbeek AL, de Koning HJ, Holland R (2005) Effect of recall rate on earlier screen detection of breast cancers based on the Dutch performance indicators. J Natl Cancer Inst 97(10):748–754

    Article  PubMed  Google Scholar 

  7. van den Akker-van Marle E, de Koning H, Boer R, van der Maas P (1999) Reduction in breast cancer mortality due to the introduction of mass screening in the Netherlands: comparison with the United Kingdom. J Med Screen 6(1):30–34

    PubMed  Google Scholar 

  8. de Koning HJ, Fracheboud J, Boer R, Verbeek AL, Collette HJ, Hendriks JH, van Ineveld BM, de Bruyn AE, van der Maas PJ (1995) Nation-wide breast cancer screening in The Netherlands: support for breast-cancer mortality reduction. National Evaluation Team for Breast Cancer Screening (NETB). Int J Cancer 60(6):777–780

    Article  PubMed  Google Scholar 

  9. Groenewoud JH, Pijnappel RM, van den Akker-Van Marle ME, Birnie E, Buijs-van der Woude T, Mali WP, de Koning HJ, Buskens E (2004) Cost-effectiveness of stereotactic large-core needle biopsy for nonpalpable breast lesions compared to open-breast biopsy. Br J Cancer 90(2):383–392

    Article  PubMed  CAS  Google Scholar 

  10. Rijnsburger AJ, Essink-Bot ML, van Dooren S, Borsboom GJ, Seynaeve C, Bartels CC, Klijn JG, Tibben A, de Koning HJ (2004) Impact of screening for breast cancer in high-risk women on health-related quality of life. Br J Cancer 91(1):69–76

    Article  PubMed  CAS  Google Scholar 

  11. Nyström L, Rutqvist LE, Wall S, Lindgren A, Lindqvist M, Rydén S, Andersson I, Bjurstam N, Fagerberg G, Frisell J, Tabár L, Larsson LG (1993) Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet 341(8851):973–978

    Article  PubMed  Google Scholar 

  12. Denton ER, Field S (1997) Just how valuable is double reporting in screening mammography? Clin Radiol 52:466–468

    Article  PubMed  CAS  Google Scholar 

  13. Séradour B, Wait S, Jacquemier J, Dubuc M (1996) Dual reading in a non-specialized breast cancer screening programme. Breast 5:398–403

    Article  Google Scholar 

  14. Anderson ED, Muir BB, Walsh JS, Kirkpatrick AE (1994) The efficacy of double reading mammograms in breast screening. Clin Radiol 49:248–251

    Article  PubMed  CAS  Google Scholar 

  15. Thurfjell EL, Lernevall KA, Taube AA (1994) Benefit of independent double reading in a population-based mammography screening program. Radiology 191:241–244

    PubMed  CAS  Google Scholar 

  16. Brown J, Bryan S, Warren R (1996) Mammography screening: an incremental cost effectiveness analysis of double versus single reading of mammograms. BMJ 312:809–812

    PubMed  CAS  Google Scholar 

  17. Warren RM, Duffy SW (1995) Comparison of single reading with double reading of mammograms, and change in effectiveness with experience. Br J Radiol 68(813):958–962

    Article  PubMed  CAS  Google Scholar 

  18. Anttinen I, Pamilo M, Soiva M, Roiha M (1993) Double reading of mammography screening films—one radiologist or two? Clin Radiol 48:414–421

    Article  PubMed  CAS  Google Scholar 

  19. Ciatto S, Ambrogetti D, Bonardi R, Catarzi S, Risso G, Rosselli Del Turco M, Mantellini P (2005) Second reading of screening mammograms increases cancer detection and recall rates. Results in the Florence screening programme. J Med Screen 12(2):103–106

    Article  PubMed  CAS  Google Scholar 

  20. Pauli R, Hammond S, Cooke J, Ansell J (1996) Comparison of radiographer/radiologist double film reading with single reading in breast cancer screening. J Med Screen 3(1):18–22

    PubMed  CAS  Google Scholar 

  21. Blanks RG, Wallis MG, Moss SM (1998) A comparison of cancer detection rates achieved by breast cancer screening programmes by number of readers, for one and two view mammography: results from the UK National Health Service breast screening programme. J Med Screen 5(4):195–201

    PubMed  CAS  Google Scholar 

  22. Ciatto S, Ambrogetti D, Risso G, Catarzi S, Morrone D, Mantellini P, Rosselli Del Turco M (2005) The role of arbitration of discordant reports at double reading of screening mammograms. J Med Screen 12:125–127

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge H. Rijken and M. Jacobs of the National Expert and Training Centre for breast cancer screening for their help with the study. Rob Boer of the Department of Public Health, is gratefully acknowledged for his contribution to the study design and the model calculations. We also would like to acknowledge the radiologists who participated in the study: Y.T. van Aardenne, D. Beijerinck, C. Boetes, J.H.B. Boomsma, W.G.J. Bors, A.C.W. Borstlap, P.A.M. Bun ev. Sevenstern, A. van Dalen, J.J.M. Deurenberg, H.A.J. Dijkstra, F.H. Jansen, B.A.E. van der Lande, T.H. Lauw, S.J. Liem, R.A. Manoliu, W.R. Obermann, E. Paalman, S.T. Parabirsing, R.M. Pijnappel, D.J. Reiding, J.L. Schreutelkamp, J. Schut, C.M. Stassen, P.T. Thung, P. Tirajoh, E.B.W. Treu. The following screening regions provided the mammograms for our test set: Preventicon, Stichting Bevolkingsonderzoek Borstkanker Noord-Nederland (BBNN), Stichting Vroege Opsporing Kanker Oost-Nederland (SVOKON), Stichting Bevolkingsonderzoek Borstkanker Zuid (BOBZ), Stichting Kankerpreventie en -screening Limburg (SKsL). This paper was completed in remembrance of Dr Jan H.C.L. Hendriks, who died 16 June 2004. This study was supported by a grant from the Health Care Insurance Board.

Author information

Authors and Affiliations

  1. Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000, CA Rotterdam, The Netherlands

    J. H. Groenewoud, J. Fracheboud, G. Draisma & H. J. de Koning

  2. Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    J. D. M. Otten & A. L. M. Verbeek

  3. Institute for Medical Technology Assessment, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    B. M. van Ineveld

  4. National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands

    R. Holland & A. L. M. Verbeek

Authors
  1. J. H. Groenewoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. D. M. Otten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Fracheboud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Draisma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. M. van Ineveld
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Holland
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. L. M. Verbeek
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. J. de Koning
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the National Evaluation Team for Breast Cancer Screening (NETB)

Corresponding author

Correspondence to H. J. de Koning.

Additional information

The NETB consists of H.J. de Koning (chair), J. Fracheboud, S.J. Otto, J.H. Groenewoud, G. Draisma, A.E. de Bruijn, Department of Public Health, Erasmus MC, University Medical Center Rotterdam; B.M. van Ineveld, Institute for Medical Technology Assessment, Erasmus MC, University Medical Center Rotterdam; F. van der Horst, National Expert and Training Centre for Breast Cancer Screening, Nijmegen; M.J.M. Broeders, A.L.M. Verbeek, Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Groenewoud, J.H., Otten, J.D.M., Fracheboud, J. et al. Cost-effectiveness of different reading and referral strategies in mammography screening in the Netherlands. Breast Cancer Res Treat 102, 211–218 (2007). https://doi.org/10.1007/s10549-006-9319-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-006-9319-4

Keywords

Search

Navigation