The value of the second view in screening mammography

Area of Science:

• Radiology
• Oncology
• Public Health

Background:

• The UK National Breast Screening Programme (UKNBSP) aims to detect breast cancer early.
• Screening mammography techniques, including one-view and two-view imaging, are continuously evaluated for efficacy.

Purpose of the Study:

• To compare cancer detection and recall rates between one-view and two-view mammography techniques within the UKNBSP.
• To assess the impact of the two-view technique on biopsy rates and associated costs.

Main Methods:

• A prospective study involving 33,734 women screened during the prevalent round of the UKNBSP.
• Radiologists read single oblique views without knowledge of subsequent craniocaudal views to mitigate bias.
• Cancer detection rates, recall rates, and biopsy rates were compared between the one-view and two-view techniques.

Main Results:

• The two-view technique increased cancer detection from 7.6 to 8.2 per thousand women, identifying 14 additional cancers (6.5% of screen-detected cancers).
• Recall rates significantly decreased from 8.8% to 6.6% with the two-view approach (p < 0.001).
• Biopsy rates were higher in the two-view group (10.6/1000 vs. 8.6/1000, p = 0.004), capturing smaller invasive cancers.

Conclusions:

• The two-view mammography technique enhances breast cancer detection and reduces recall rates in the UKNBSP.
• While increasing biopsy rates, the additional cancers detected are often small and invasive, justifying the higher rate.
• Implementing two-view screening has resource implications but offers significant benefits for early cancer diagnosis.