Ask Anne: Does double reading really improve detection rates in screening mammography?

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As someone who has watched numerous debates about mammography screening transpire, there’s one “standard” that we can all agree on: double reading, of any kind, improves detection rates and can save lives.

Numerous studies lend evidence to the effectiveness of double reading*—whereby at least two radiologists interpret the same mammographic examination. More recently, computer-aided detection (CAD) has emerged as a way to utilize sophisticated software to highlight suspicious areas, enabling the radiologist to examine these areas a second time to maximize accuracy.

Screening conventions around the world differ extensively. In Europe, for example, double reading is a common practice in more than a dozen countries. Many of these countries, in addition to Australia, New Zealand and Canada, practice “population-based” screening, whereby a centralized screening or health organization formally invites women to participate in screening at a pre-determined age. Once a woman enters into the system, population- and age-based metrics can be tracked including program participation, detection and mortality rates, and more.

In the U.S., where screening is provided in diverse settings that include private clinics, hospitals settings and academic medical centers, double reading is used but not mandated. Fortunately, most U.S. insurance companies now include CAD as part of their regular screening coverage.

As a women’s imaging technology supplier, our goal is to provide tools that support the myriad screening reading conventions that exist worldwide. When examining imaging and information systems for double reading, look for RIS or PACS that can drive an efficient workflow for two different reads for a single patient—with the ability to automatically flag and/or recall patients when there are contradictory findings.

If you’d like to add CAD, look for a PACS platform that integrates with robust digital CAD software—which allows radiologists to read the exam and then activate the CAD analysis. Ultimately, you should develop a workflow that not only helps you report but also enables you to track double-reading results for regular medical outcomes audits of the mammography practice for ongoing self-assessment.

What screening reading conventions does your facility/country adhere to? How can we better support you?

– Anne Richards, Clinical Development Manager, Women’s Healthcare

* There are numerous studies supporting double reading, including:

• Gilbert, FJ, Astley, SM, Gillan, M, Agbaje, O F, Wallis, M G, James, J, Boggis, C, Duffy, S W, Single reading with Computer-Aided Detection for screening Mammography. NEJM 2008, Volume 359:1675-1684.
• Thurfjell E, Lernevall K, Taube A. Benefit of independent double reading in a population-based mammography screening program. Radiology 1994;191:241-244.
• Ciatto S, Del Turco M, Morrone D, et al. Independent double reading of screening mammograms. J Med Screen 1995;2:99-101.
• Anttinen I, Pamilo M, Soiva M et al. Double reading of mammography screening films- one radiologist or two? Clin Radiol 1993;48:414-421.

Editor’s Note: “Ask Anne” is a new monthly installment in which we pose a mammography-focused question to Carestream Health Women’s Health Clinical Development Manager and all-around mammography expert, Anne Richards. Got a question for Anne? Add it in the comments section below!