Breast cancers missed by screening radiologists can be detected by reading mammograms at a distance

BackgroundDuring locally organized quality assurance evaluation sessions for screening radiologists, we noticed that individual screening radiologists did miss tumours which in our opinion could be detected at a distance.AimTo determine whether tumours missed by individual screening radiologists can be detected at a distance.MethodsTwenty-eight screening mammograms of 28 females (mean age 63years, range 49-73) with a pathologically proven malignant tumour missed by individual screening radiologists were mixed with 56 normal screening mammograms of 56 females (mean age 63years, range 53-74). This test set was independently assessed by a senior screening radiologist and by a radiology resident without prior training in screening mammography at 1.5m distance from the screen display. Readers were unaware of the prevalence of pathologically proven malignant tumours in the test set. Primary outcome was whether the reader would recall the woman.ResultsThe senior screening radiologist recalled 28 of 28 women with a pathologically proven malignant tumour (sensitivity of 100%) and 16 of 56 women without pathology (specificity of 71%). The radiology resident recalled 25 of 28 women with a pathologically proven malignant tumour (sensitivity of 89%) and 10 of 56 women without pathology (specificity of 82%).ConclusionSome malignant tumours missed by an individual screening radiologist can be detected from 1.5m distance. Therefore, we recommend that screening radiologists consciously take a distant view before closely evaluating the mammogram in detail.