title: Can the NHS Breast Screening Programme afford not to double read screening mammograms?
abstract: OBJECTIVE
  Rapid expansion of the National Health Service (UK) Breast Screening Programme (NHSBSP) to routinely invite women aged 50-70 years will result in many new readers undertaking screen reading. A timely method for assessing performance and preferably one that facilitates a steep learning curve will be required.
  
  
  METHODS
  This unit screens a population of 88000 women aged 50-64 years and double reads >90% films. A record is kept of proven screen-detected cancers not recalled for assessment by either the first or second reader but correctly recalled following third-reader arbitration. Individual readers' workload and recall rates are obtained by running an annual co-writer report. The results of this 7 year prospective audit are presented.
  
  
  RESULTS
  In total 177167 women were screened between 1/4/95 and 31/3/02 resulting in the detection of 1072 cancers. Eighty-seven cancers (8.1%) were detected after arbitration. Individual readers recall to assessment rates and percentage of cases incorrectly returned to routine recall varied. Prompt feedback of missed/misinterpreted cases allowed both experienced and inexperienced readers to modify their recall thresholds for particular mammographic abnormalities.
  
  
  CONCLUSIONS
  It is recommended this audit method is adopted by all units in the NHSBSP and that the Advisory Committee for Breast Cancer Screening review the policy of single versus double reading.
authors.affiliation: Leeds Wakefield Breast Screening Service, Seacroft Hospital, Leeds, UK. joyce.liston@leedsth.nhs.uk
authors.forename: J C
authors.initials: JC
authors.lastname: Liston
authors.forename: B J G
authors.initials: BJ
authors.lastname: Dall
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002983:Clinical Competence; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008485:Medical Audit / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards; D013222:State Medicine; D006113:United Kingdom