Impact of the second reader on screening outcome at blinded double reading of digital screening mammograms

Angela M. P. Coolen*, Adri C. Voogd, Luc J. Strobbe, Marieke W. J. Louwman, Vivianne C. G. Tjan-Heijnen, Lucien E. M. Duijm

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

12 Citations (Web of Science)


BACKGROUND: To determine the impact of the second reader on screening outcome at blinded double reading of digital screening mammograms. METHODS: We included a consecutive series of 99,013 digital screening mammograms, obtained between July 2013 and January 2015 and double read in a blinded fashion. During 2-year follow-up, we collected radiology, surgery and pathology reports of recalled women. RESULTS: Single reading resulted in 2928 recalls and 616 screen-detected cancers (SDCs). The second reader recalled another 612 women, resulting in 82 additional SDCs. Addition of the second reader increased the recall rate (3.0% to 3.6%, p < 0.001), cancer detection rate (6.2-7.0 per 1000 screens, p < 0.001) and false positive recall rate (24.4-28.7 per 1000 screens, p < 0.001). Positive predictive value of recall (21.0% vs. 19.7%, p = 0.20) and of biopsy (52.1% vs. 50.9%, p = 0.56) were comparable for single reading and blinded double reading. Tumour characteristics were comparable for cancers detected by the first reader and cancers additionally detected by the second reader, except of a more favourable tumour grade in the latter group. CONCLUSIONS: At blinded double reading, the second reader significantly increases the cancer detection rate, at the expense of an increased recall rate and false positive recall rate.
Original languageEnglish
Pages (from-to)503-507
Number of pages5
JournalBritish Journal of Cancer
Issue number4
Publication statusPublished - 14 Aug 2018



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