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Optimising breast cancer screening reading : blinding the second reader to the first reader’s decisions
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Cooper, Jennifer Anne, Jenkinson, David J., Stinton, Chris, Wallis, Matthew G., Hudson, Sue and Taylor-Phillips, Sian (2022) Optimising breast cancer screening reading : blinding the second reader to the first reader’s decisions. European Radiology, 32 . pp. 602-612. doi:10.1007/s00330-021-07965-z ISSN 0938-7994.
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Official URL: https://doi.org/10.1007/s00330-021-07965-z
Abstract
Objectives
In breast cancer screening, two readers separately examine each woman’s mammograms for signs of cancer. We examined whether preventing the two readers from seeing each other’s decisions (blinding) affects behaviour and outcomes.
Methods
This cohort study used data from the CO-OPS breast-screening trial (1,119,191 women from 43 screening centres in England) where all discrepant readings were arbitrated. Multilevel models were fitted using Markov chain Monte Carlo to measure whether reader 2 conformed to the decisions of reader 1 when they were not blinded, and the effect of blinding on overall rates of recall for further tests and cancer detection. Differences in positive predictive value (PPV) were assessed using Pearson’s chi-squared test.
Results
When reader 1 recalls, the probability of reader 2 also recalling was higher when not blinded than when blinded, suggesting readers may be influenced by the other’s decision. Overall, women were less likely to be recalled when reader 2 was blinded (OR 0.923; 95% credible interval 0.864, 0.986), with no clear pattern in cancer detection rate (OR 1.029; 95% credible interval 0.970, 1.089; Bayesian p value 0.832). PPV was 22.1% for blinded versus 20.6% for not blinded (p < 0.001).
Conclusions
Our results suggest that when not blinded, reader 2 is influenced by reader 1’s decisions to recall (alliterative bias) which would result in bypassing arbitration and negate some of the benefits of double-reading. We found a relationship between blinding the second reader and slightly higher PPV of breast cancer screening, although this analysis may be confounded by other centre characteristics.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Journal or Publication Title: | European Radiology | |||||||||
| Publisher: | Springer | |||||||||
| ISSN: | 0938-7994 | |||||||||
| Official Date: | January 2022 | |||||||||
| Dates: |
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| Volume: | 32 | |||||||||
| Page Range: | pp. 602-612 | |||||||||
| DOI: | 10.1007/s00330-021-07965-z | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Reuse Statement (publisher, data, author rights): | This is a post-peer-review, pre-copyedit version of an article published in European Radiology. The final authenticated version is available online at: https://doi.org/10.1007/s00330-021-07965-z | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 25 March 2021 | |||||||||
| Date of first compliant Open Access: | 1 September 2021 | |||||||||
| RIOXX Funder/Project Grant: |
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