The objective of this question is to determine whether reading mammograms by double reading (independent or dependent, blinded or not) with a consensus conference or with arbitration is superior to single reading.

Healthcare question

Should double reading (with consensus or arbitration for discordant readings) vs. single reading be used to screen mammograms for early detection of breast cancer in mammography screening programmes?

Recommendation

The ECIBC's Guidelines Development Group (GDG) suggests using double reading (with consensus or arbitration for discordant readings) over single reading to screen mammograms for early detection of breast cancer in mammography screening programmes.

Recommendation strength ­

 Conditional recommendation for the intervention

 Moderate certainty of the evidence

Subgroup considerations

The GDG notes that in the context of double reading with consensus or arbitration, no differences were observed in accuracy when arbitration or consensus or both were used to reconcile differences in interpretation between mammography readers.

Considerations for implementation and policy making

  1. In settings with many low-volume mammography readers, the balance of benefits and harms may be even greater. Please refer to the report on the Question: ‘What is the optimal annual interpretive volume for radiologists reading screening mammograms?’ regarding the experience level of mammography readers listed in bibliography.
  2. In some settings, capacity (human resources of mammography readers) should be scaled up to implement double readings. In settings where double readings are already in practice, it is suggested the continued use of double readings with consensus or arbitration.
  3. A consideration that can favour double reading with consensus or arbitration is in those settings with many low-volume mammography readers. The desirable effects of double reading with consensus or arbitration were found to be greater with less undesirable effects in these settings as compared to high-volume mammography reader settings.

Monitoring and evaluation

The GDG suggests reporting the proportion of double reading with consensus or arbitration of mammograms that occur in practice. The GDG refers this suggestion to the Quality Assurance Scheme Development Group (QASDG) for consideration.

Supporting documents