title: Double versus single reading of mammograms in a breast cancer screening programme: a cost-consequence analysis.
abstract: OBJECTIVE
  To assess the costs and health-related outcomes of double versus single reading of digital mammograms in a breast cancer screening programme.
  
  
  METHODS
  Based on data from 57,157 digital screening mammograms from women aged 50-69 years, we compared costs, false-positive results, positive predictive value and cancer detection rate using four reading strategies: double reading with and without consensus and arbitration, and single reading with first reader only and second reader only. Four highly trained radiologists read the mammograms.
  
  
  RESULTS
  Double reading with consensus and arbitration was 15 % (Euro 334,341) more expensive than single reading with first reader only. False-positive results were more frequent at double reading with consensus and arbitration than at single reading with first reader only (4.5 % and 4.2 %, respectively; p < 0.001). The positive predictive value (9.3 % and 9.1 %; p = 0.812) and cancer detection rate were similar for both reading strategies (4.6 and 4.2 per 1000 screens; p = 0.283).
  
  
  CONCLUSIONS
  Our results suggest that changing to single reading of mammograms could produce savings in breast cancer screening. Single reading could reduce the frequency of false-positive results without changing the cancer detection rate. These results are not conclusive and cannot be generalized to other contexts with less trained radiologists.
  
  
  CONCLUSIONS
  • Double reading of digital mammograms is more expensive than single reading. • Compared to single reading, double reading yields a higher proportion of false-positive results. • The cancer detection rate was similar for double and single readings. • Single reading may be a cost-effective strategy in breast cancer screening programmes.
authors.affiliation: Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. mposso@cochrane.es.|Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret, 167. Pavelló 18, planta 0, CP: 08025, Barcelona, Spain. mposso@cochrane.es.
authors.forename: Margarita C
authors.initials: MC
authors.lastname: Posso
authors.affiliation: Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.|Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Puig
authors.affiliation: Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: Ma Jesus
authors.initials: MJ
authors.lastname: Quintana
authors.affiliation: Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.
authors.forename: Judit
authors.initials: J
authors.lastname: Solà-Roca
authors.affiliation: Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.|Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Bonfill
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008327:Mammography / Q000191:economics* / Q000379:methods*; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D015588:Observer Variation
keywords: Breast neoplasms; Costs and cost analysis; Early detection of cancer; Mammography; Mass screening