Cornford, Eleanor, Cheung, Shan, Press, Mike, Kearins, Olive and Taylor-Phillips, Sian (2021) Optimum screening mammography reading volumes : evidence from the NHS Breast Screening Programme. European Radiology . doi:10.1007/s00330-021-07754-8 (In Press)

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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.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RG Gynecology and obstetrics
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Breast -- Cancer, Breast -- Magnetic resonance imaging , Medical screening
Journal or Publication Title:	European Radiology
Publisher:	Springer
ISSN:	0938-7994
Official Date:	2021
Dates:	Date Event 2021 Published 25 February 2021 Available 4 February 2021 Accepted
DOI:	10.1007/s00330-021-07754-8
Status:	Peer Reviewed
Publication Status:	In Press
Publisher Statement:	This is a post-peer-review, pre-copyedit version of an article published in European Radiology. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00330-021-07754-8
Access rights to Published version:	Restricted or Subscription Access

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