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R.T. readings improve cancer detection.

Article Excerpt
The addition of an independent double reading of mammograms by radiologic technologists to an independent double reading by radiologists helps detect more breast cancers, according to a new study from the Netherlands. Researchers concluded that all technologist-positive readings should be considered for referral because this subset of screening mammograms showed a high prevalence of breast cancer.

In the Netherlands, screening technologists have been encouraged to look for mammographic abnormalities since 1995. The technologists attend quality assurance sessions once every 3 weeks, where they bring to the attention of a supervising breast radiologist any mammographic abnormalities they have identified that may require additional workup. As a result of this intensive and continuous education, the screening technologists gain considerable experience in reading mammograms.

Dutch researchers studied the effects on screening performance of adding an independent double reading of screening mammograms by technologists. Twenty-one screening mammography technologists and 8 certified screening radiologists reviewed 61 251 screening mammograms obtained at 2 mammography screening units. Radiologists were unaware of the referral opinion of the technologists. During a 2-year follow-up period, researchers collected clinical data, breast imaging reports, biopsy results and breast surgery reports of all women with a positive screening result from any reader.

The radiologists referred 905 women, of whom 323 had breast cancer, corresponding to a positive predictive value of 35.7%. Review of 446 additional technologist-positive readings led to another 80 referrals, resulting in the detection of 22 additional cancers. These extra referrals increased the initial referral rate from 1.48% to 1.61% and the cancer detection rate from 5.27 to 5.63 cancers per 1000 women screened. With technologist double reading only, 829 women would have been referred; among these women, 286 had cancer. Referral of all 1351 radiologist-and technologist-positive readings would have led to 362 cancers found at screening. The cancer detection rate for radiologist double reading would have increased from 5.27 to 5.91 cancers per 1000 women screened.

"A referral strategy that includes all technologist-positive readings, which would have increased the cancer detection rate while maintaining a low referral rate, should be considered," said Lucien E. M. Duijm, M.D., Ph.D., from Catharina Hospital in Eindhoven, the Netherlands, and colleagues. The study appeared in the July 24 issue of the Journal of the National Cancer Institute.

Dr Duijm noted that independent double reading of mammograms by technologists would result in extra costs, including extra wages for technologists and the costs associated with having more women who require additional diagnostic assessment. However, those costs could be offset by increased detection of early-stage breast cancers, which require less invasive treatments.

"Additional independent double reading of mammograms by technologists is likely to be a cost-effective approach in a screening program that is characterized by low referral rates such as that in the Netherlands," concluded Dr Duijm.

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