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Evaluation of the impact of a third mammographic reading in the French population-based breast cancer screening
Akoï Koïvogui1, Samira Saifi1, Malala Razafija1
1CRCDC-IDF, 28 rue Desaix, Paris 75015, France.
Background:
The population-based breast cancer screening program (PBCSP) in France relies on a systematic second reading (Read-2) of mammograms initially interpreted as normal or benign at the first reading (Read-1). To reduce false-positive results and avoid unnecessary diagnostic procedures, a third reading (Read-3) was implemented in two French departments. This study evaluates its impact in terms of the incidence of interval cancers.
Methods:
The retrospective cohort study includes 1328,597 index mammograms (MT0) classified as negative in Read-1 and reviewed in Read-2. These MT0 were performed between 2001 and 2022 on 426,603 women aged 50-74 years, residing in Seine-Saint-Denis and Val-d'Oise, France. Two groups were compared: i)- Index mammograms classified as negative in Read-2 (Control-group, 1312,341 MT0); ii)- Index mammograms initially positive in Read-2 but reclassified as negative in Read-3 (Third-reading-group, 16,256 MT0). Two hierarchical models explored the determinants of positivity in Read-2 and Read-3. The incidence of cancers, particularly interval cancer (≤23 months after Index mammograms), were compared using an adjusted Cox proportional Hazard-ratio model.
Results:
Confirmation of positivity by Read-3 was more likely when the radiological abnormality (Architectural-distortion, Focal-asymmetry, Microcalcifications, Round-mass, Spiculated-mass) was seen in Read-3, regardless of the assessment made in Read-2. The risk of interval cancer was higher in the Third-reading-group (Hazard-ratio=2.1 [1.2-3.8], p = 0.009). However, no increased risk was observed beyond 24 months (Hazard-ratio=0.9 [0.7-1.2], p = 0.52). Read-3 avoided more than 6000 ultrasounds, 700 biopsies, and nearly 7600 additional mammograms.
Conclusion:
While it reduces the overuse of exams, Read-3 was associated with a higher interval cancer risk. These results underline the interest of a national reflection on the place of a targeted Read-3 with a security reference framework, or even its replacement by AI-based decision-making tools.
