Two-view versus single-view mammography at subsequent screening in a region of the Dutch breast screening programme

We retrospectively determined the effect of analogue two-view mammography versus single-view mammography at subsequent screens on breast cancer detection and determined financial consequences for a current digital mammography setting. Two screening radiologists reviewed the mammograms of 536 screen detected cancers (SDCs) and 171 interval cancers (ICs) with single-view mammography (medio-lateral-oblique view) at the last but one screen (SDCs) or latest screen (ICs). They determined whether two-view mammography at the last (but one) screen could have increased the cancer detection rate at that screening round. For subsequent screens, the radiologists also assessed the percentage of SDCs and ICs that had been missed at previous two-view screening mammography (SDC) or latest two-view screening (IC), respectively. Additional personnel and digital storage costs for standard two-view mammography at subsequent screening were calculated for digital screening. Two-view mammography could have facilitated earlier cancer detection in 40.9% (219/536) of SDCs and 39.8% (68/171) of ICs. For two-view screens, 24.4% of SDCs (213/871) were missed at previous two-view screening and 29.3% of ICs (110/375) were missed at the latest screen. Overall costs increase € 1.03/screen after implementation of digital two-view mammography. Standard two-view mammography at subsequent screening may modestly increase cancer detection at an earlier stage, whereas additional screening costs are limited.