Additional mammogram review improves cancer detection

Breast cancer treatment is significantly more successful when the disease is discovered early. However, sometimes radiologists miss the small early signs of an abnormality.

Dr. Lucien E.M. Duijm from Catharina Hospital in Eindhoven, the Netherlands, and his colleagues examined whether adding readings by technologists to the standard double readings by radiologists might help increase cancer detection rates.

As reported in the Aug. 1 issue of Journal of the National Cancer Institute, 21 technologists and eight radiologists read 61,251 mammograms of women aged 50 to 75 who were screened at one of two locales in the Netherlands. Two technologists first independently read each mammogram and recorded whether they found anything suspicious that needed further examination. If the technologists had different evaluations, they tried to reach a consensus. But if one still believed the mammogram contained something suspicious, the mammogram was recorded as positive.

After the technologists’ readings, two radiologists then read each mammogram but were blinded to the referral opinion of the technologists. Like the technologists, the radiologists tried to reach a consensus if they had discrepancies in their readings. A patient was referred for further examination if the mammogram was considered abnormal by both screening radiologists after initial double reading or, in the case of discrepant readings, if at least one radiologist considered referral necessary after consensus.

Within three weeks, the mammograms that the technologists had considered positive were reviewed again by two screening radiologists (with the technologists’ findings revealed). If at least one of the radiologists confirmed a positive finding, the patient also was referred for further examination.

The researchers found that the radiologists referred 905 women, of which 323 had breast cancer. And the technologists reported an additional 446 women, which led to another 80 referrals by the radiologists. These 80 referrals resulted in the detection of 22 additional cancers.

They concluded that including technologists’ readings could help increase the rate of breast cancer detection.