Performance Metrics of Mammography Screening Programmes in Primary Health Care Centres in Bahrain

Mammography is the cornerstone of breast cancer screening. Its diagnostic performance, however, is influenced by population demographics such as age and breast density.

The aim of this study was to establish contemporary performance benchmarks for mammography screening in Bahrain's primary health-care centres (PHCs) and to identify areas for quality improvement.

A cross-sectional retrospective analysis was performed on mammograms from asymptomatic women aged ≥40 years who were screened in 2020 at primary health care centres. Screening outcomes were cross-referenced with subsequent breast cancer diagnoses recorded in the Bahrain Cancer Registry (2021-2022). Mammographic findings were categorised using the Breast Imaging Reporting and Data System (BI-RADS), and performance metrics including the cancer detection rate (CDR), sensitivity, and specificity were calculated.

A total of 2196 screening mammograms were included, with a mean patient age of 56.1 years. The cancer detection rate was 12.3 per 1000 screens, and the recall rate was 30.6%. Sensitivity and specificity were 69.2% and 71.2%, respectively, and the interval cancer rate was 5.4 per 1000. The most common breast density category was "scattered fibroglandular" (61.8%). Recall rates were significantly associated with breast density (p < 0.001). Among the 39 patients diagnosed with breast cancer, invasive ductal carcinoma was the most prevalent subtype (71.8%).

The findings highlight the moderate utility of mammography screening in Bahrain, characterised by a relatively high recall rate and a need to optimise reporting standards and recall criteria. Tailored strategies such as supplemental imaging for women with dense or high-risk breasts, strict adherence to BI-RADS guidelines, and implementing double reading or single reading with computer-aided detection could improve screening outcomes. These results establish important regional performance benchmarks and can inform policies to enhance breast cancer detection and management in the Arabian Gulf region.