Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection A Randomized Clinical Trial

S. Taylor-Phillips, M. G. Wallace, D. Jenkinson, V. Adekanmbi, H. Parsons, J. Dunn, N. Stallard, Ala Szczepura, S. Gates, O. Kearins, A. Duncan, S. Hudson, A. Clarke

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    Abstract

    Importance Interpreting screening mammograms is a difficult repetitive task that can result in missed cancers and false-positive recalls. In the United Kingdom, 2 film readers independently evaluate each mammogram to search for signs of cancer and examine digital mammograms in batches. However, a vigilance decrement (reduced detection rate with time on task) has been observed in similar settings. Objective To determine the effect of changing the order for the second film reader of batches of screening mammograms on rates of breast cancer detection. Design, Setting, and Participants A multicenter, double-blind, cluster randomized clinical trial conducted at 46 specialized breast screening centers from the National Health Service Breast Screening Program in England for 1 year (all between December 20, 2012, and November 3, 2014). Three hundred sixty readers participated (mean, 7.8 readers per center)—186 radiologists, 143 radiography advanced practitioners, and 31 breast clinicians, all fully qualified to report mammograms in the NHS breast screening program. Interventions The 2 readers examined each batch of digital mammograms in the same order in the control group and in the opposite order to one another in the intervention group. Main Outcomes and Measures The primary outcome was cancer detection rate; secondary outcomes were rates of recall and disagreements between readers. Results Among 1 194 147 women (mean age, 59.3; SD, 7.49) who had screening mammograms (596 642 in the intervention group; 597 505 in the control group), the images were interpreted in 37 688 batches (median batch size, 35; interquartile range [IQR]; 16-46), with each reader interpreting a median of 176 batches (IQR, 96-278). After completion of all subsequent diagnostic tests, a total of 10 484 cases (0.88%) of breast cancer were detected. There was no significant difference in cancer detection rate with 5272 cancers (0.88%) detected in the intervention group vs 5212 cancers (0.87%) detected in the control group (difference, 0.01% points; 95% CI, −0.02% to 0.04% points; recall rate, 24 681 [4.14%] vs 24 894 [4.17%]; difference, −0.03% points; 95% CI, −0.10% to 0.04% points; or rate of reader disagreements, 20 471 [3.43%] vs 20 793 [3.48%]; difference, −0.05% points; 95% CI, −0.11% to 0.02% points). Conclusions and Relevance Interpretation of batches of mammograms by qualified screening mammography readers using a different order vs the same order for the second reading resulted in no significant difference in rates of detection of breast cancer. Trial Registration isrctn.org Identifier: ISRCTN46603370
    Original languageEnglish
    Pages (from-to)1956-1965
    JournalThe Journal of the American Medical Association
    Volume215
    Issue number18
    DOIs
    Publication statusPublished - 10 May 2016

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    Randomized Controlled Trials
    Breast Neoplasms
    Breast
    Neoplasms
    Control Groups
    National Health Programs
    Mammography
    Routine Diagnostic Tests
    Radiography
    England
    Outcome Assessment (Health Care)

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    Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection A Randomized Clinical Trial. / Taylor-Phillips, S.; Wallace, M. G.; Jenkinson, D.; Adekanmbi, V.; Parsons, H.; Dunn, J.; Stallard, N.; Szczepura, Ala; Gates, S.; Kearins, O.; Duncan, A.; Hudson, S.; Clarke, A.

    In: The Journal of the American Medical Association, Vol. 215, No. 18, 10.05.2016, p. 1956-1965.

    Research output: Contribution to journalArticle

    Taylor-Phillips, S, Wallace, MG, Jenkinson, D, Adekanmbi, V, Parsons, H, Dunn, J, Stallard, N, Szczepura, A, Gates, S, Kearins, O, Duncan, A, Hudson, S & Clarke, A 2016, 'Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection A Randomized Clinical Trial' The Journal of the American Medical Association, vol. 215, no. 18, pp. 1956-1965. https://doi.org/10.1001/jama.2016.5257
    Taylor-Phillips, S. ; Wallace, M. G. ; Jenkinson, D. ; Adekanmbi, V. ; Parsons, H. ; Dunn, J. ; Stallard, N. ; Szczepura, Ala ; Gates, S. ; Kearins, O. ; Duncan, A. ; Hudson, S. ; Clarke, A. / Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection A Randomized Clinical Trial. In: The Journal of the American Medical Association. 2016 ; Vol. 215, No. 18. pp. 1956-1965.
    @article{012223b4c7b540338e7dba523ebe4cff,
    title = "Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection A Randomized Clinical Trial",
    abstract = "Importance Interpreting screening mammograms is a difficult repetitive task that can result in missed cancers and false-positive recalls. In the United Kingdom, 2 film readers independently evaluate each mammogram to search for signs of cancer and examine digital mammograms in batches. However, a vigilance decrement (reduced detection rate with time on task) has been observed in similar settings. Objective To determine the effect of changing the order for the second film reader of batches of screening mammograms on rates of breast cancer detection. Design, Setting, and Participants A multicenter, double-blind, cluster randomized clinical trial conducted at 46 specialized breast screening centers from the National Health Service Breast Screening Program in England for 1 year (all between December 20, 2012, and November 3, 2014). Three hundred sixty readers participated (mean, 7.8 readers per center)—186 radiologists, 143 radiography advanced practitioners, and 31 breast clinicians, all fully qualified to report mammograms in the NHS breast screening program. Interventions The 2 readers examined each batch of digital mammograms in the same order in the control group and in the opposite order to one another in the intervention group. Main Outcomes and Measures The primary outcome was cancer detection rate; secondary outcomes were rates of recall and disagreements between readers. Results Among 1 194 147 women (mean age, 59.3; SD, 7.49) who had screening mammograms (596 642 in the intervention group; 597 505 in the control group), the images were interpreted in 37 688 batches (median batch size, 35; interquartile range [IQR]; 16-46), with each reader interpreting a median of 176 batches (IQR, 96-278). After completion of all subsequent diagnostic tests, a total of 10 484 cases (0.88{\%}) of breast cancer were detected. There was no significant difference in cancer detection rate with 5272 cancers (0.88{\%}) detected in the intervention group vs 5212 cancers (0.87{\%}) detected in the control group (difference, 0.01{\%} points; 95{\%} CI, −0.02{\%} to 0.04{\%} points; recall rate, 24 681 [4.14{\%}] vs 24 894 [4.17{\%}]; difference, −0.03{\%} points; 95{\%} CI, −0.10{\%} to 0.04{\%} points; or rate of reader disagreements, 20 471 [3.43{\%}] vs 20 793 [3.48{\%}]; difference, −0.05{\%} points; 95{\%} CI, −0.11{\%} to 0.02{\%} points). Conclusions and Relevance Interpretation of batches of mammograms by qualified screening mammography readers using a different order vs the same order for the second reading resulted in no significant difference in rates of detection of breast cancer. Trial Registration isrctn.org Identifier: ISRCTN46603370",
    author = "S. Taylor-Phillips and Wallace, {M. G.} and D. Jenkinson and V. Adekanmbi and H. Parsons and J. Dunn and N. Stallard and Ala Szczepura and S. Gates and O. Kearins and A. Duncan and S. Hudson and A. Clarke",
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    TY - JOUR

    T1 - Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection A Randomized Clinical Trial

    AU - Taylor-Phillips, S.

    AU - Wallace, M. G.

    AU - Jenkinson, D.

    AU - Adekanmbi, V.

    AU - Parsons, H.

    AU - Dunn, J.

    AU - Stallard, N.

    AU - Szczepura, Ala

    AU - Gates, S.

    AU - Kearins, O.

    AU - Duncan, A.

    AU - Hudson, S.

    AU - Clarke, A.

    PY - 2016/5/10

    Y1 - 2016/5/10

    N2 - Importance Interpreting screening mammograms is a difficult repetitive task that can result in missed cancers and false-positive recalls. In the United Kingdom, 2 film readers independently evaluate each mammogram to search for signs of cancer and examine digital mammograms in batches. However, a vigilance decrement (reduced detection rate with time on task) has been observed in similar settings. Objective To determine the effect of changing the order for the second film reader of batches of screening mammograms on rates of breast cancer detection. Design, Setting, and Participants A multicenter, double-blind, cluster randomized clinical trial conducted at 46 specialized breast screening centers from the National Health Service Breast Screening Program in England for 1 year (all between December 20, 2012, and November 3, 2014). Three hundred sixty readers participated (mean, 7.8 readers per center)—186 radiologists, 143 radiography advanced practitioners, and 31 breast clinicians, all fully qualified to report mammograms in the NHS breast screening program. Interventions The 2 readers examined each batch of digital mammograms in the same order in the control group and in the opposite order to one another in the intervention group. Main Outcomes and Measures The primary outcome was cancer detection rate; secondary outcomes were rates of recall and disagreements between readers. Results Among 1 194 147 women (mean age, 59.3; SD, 7.49) who had screening mammograms (596 642 in the intervention group; 597 505 in the control group), the images were interpreted in 37 688 batches (median batch size, 35; interquartile range [IQR]; 16-46), with each reader interpreting a median of 176 batches (IQR, 96-278). After completion of all subsequent diagnostic tests, a total of 10 484 cases (0.88%) of breast cancer were detected. There was no significant difference in cancer detection rate with 5272 cancers (0.88%) detected in the intervention group vs 5212 cancers (0.87%) detected in the control group (difference, 0.01% points; 95% CI, −0.02% to 0.04% points; recall rate, 24 681 [4.14%] vs 24 894 [4.17%]; difference, −0.03% points; 95% CI, −0.10% to 0.04% points; or rate of reader disagreements, 20 471 [3.43%] vs 20 793 [3.48%]; difference, −0.05% points; 95% CI, −0.11% to 0.02% points). Conclusions and Relevance Interpretation of batches of mammograms by qualified screening mammography readers using a different order vs the same order for the second reading resulted in no significant difference in rates of detection of breast cancer. Trial Registration isrctn.org Identifier: ISRCTN46603370

    AB - Importance Interpreting screening mammograms is a difficult repetitive task that can result in missed cancers and false-positive recalls. In the United Kingdom, 2 film readers independently evaluate each mammogram to search for signs of cancer and examine digital mammograms in batches. However, a vigilance decrement (reduced detection rate with time on task) has been observed in similar settings. Objective To determine the effect of changing the order for the second film reader of batches of screening mammograms on rates of breast cancer detection. Design, Setting, and Participants A multicenter, double-blind, cluster randomized clinical trial conducted at 46 specialized breast screening centers from the National Health Service Breast Screening Program in England for 1 year (all between December 20, 2012, and November 3, 2014). Three hundred sixty readers participated (mean, 7.8 readers per center)—186 radiologists, 143 radiography advanced practitioners, and 31 breast clinicians, all fully qualified to report mammograms in the NHS breast screening program. Interventions The 2 readers examined each batch of digital mammograms in the same order in the control group and in the opposite order to one another in the intervention group. Main Outcomes and Measures The primary outcome was cancer detection rate; secondary outcomes were rates of recall and disagreements between readers. Results Among 1 194 147 women (mean age, 59.3; SD, 7.49) who had screening mammograms (596 642 in the intervention group; 597 505 in the control group), the images were interpreted in 37 688 batches (median batch size, 35; interquartile range [IQR]; 16-46), with each reader interpreting a median of 176 batches (IQR, 96-278). After completion of all subsequent diagnostic tests, a total of 10 484 cases (0.88%) of breast cancer were detected. There was no significant difference in cancer detection rate with 5272 cancers (0.88%) detected in the intervention group vs 5212 cancers (0.87%) detected in the control group (difference, 0.01% points; 95% CI, −0.02% to 0.04% points; recall rate, 24 681 [4.14%] vs 24 894 [4.17%]; difference, −0.03% points; 95% CI, −0.10% to 0.04% points; or rate of reader disagreements, 20 471 [3.43%] vs 20 793 [3.48%]; difference, −0.05% points; 95% CI, −0.11% to 0.02% points). Conclusions and Relevance Interpretation of batches of mammograms by qualified screening mammography readers using a different order vs the same order for the second reading resulted in no significant difference in rates of detection of breast cancer. Trial Registration isrctn.org Identifier: ISRCTN46603370

    U2 - 10.1001/jama.2016.5257

    DO - 10.1001/jama.2016.5257

    M3 - Article

    VL - 215

    SP - 1956

    EP - 1965

    JO - JAMA - Journal of the American Medical Association

    JF - JAMA - Journal of the American Medical Association

    SN - 0002-9955

    IS - 18

    ER -