The value of arbitration in a breast screening programme

Double reading with arbitration is identified as the best pattern to detect the maximum number of cancers. The balance between cancer detection and recall rates must be maintained while acknowledging the steep learning curve for new film readers in the National Health Service Breast Screening Programme. A recent study highlighted these findings [1].

We present the data on 761 arbitrated cases that support this study. Eighty per cent of first-read recalls and 57% of second-read recalls were overruled. Following review, 96% of arbitrated cases were returned to routine screen. Of the remaining 4% (n = 27), 10 were cancers and two were radial scars.

No particular pattern was identified among readers for hits or misses. Arbitration provides a group of cases where interpretation is difficult. Analysis of first reader over recall should increase specificity. Reviewing arbitrated cancers is a valuable learning exercise. Identifying specific weaknesses, strengths and arbitrator recall rates allows us to maximise the benefits of different working practices.

Can the National Health Service Breast Screening Programme afford not to double read screening mammograms?