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dc.contributor.authorCooper, Jennifer A
dc.contributor.authorJenkinson, David
dc.contributor.authorStinton, Chris
dc.contributor.authorWallis, Matthew
dc.contributor.authorHudson, Sue
dc.contributor.authorTaylor-Phillips, Sian
dc.date.accessioned2022-01-04T11:58:51Z
dc.date.available2022-01-04T11:58:51Z
dc.date.issued2022-01
dc.date.submitted2021-01-11
dc.identifier.issn0938-7994
dc.identifier.others00330-021-07965-z
dc.identifier.other7965
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/331850
dc.description.abstractOBJECTIVES: In breast cancer screening, two readers separately examine each woman's mammograms for signs of cancer. We examined whether preventing the two readers from seeing each other's decisions (blinding) affects behaviour and outcomes. METHODS: This cohort study used data from the CO-OPS breast-screening trial (1,119,191 women from 43 screening centres in England) where all discrepant readings were arbitrated. Multilevel models were fitted using Markov chain Monte Carlo to measure whether reader 2 conformed to the decisions of reader 1 when they were not blinded, and the effect of blinding on overall rates of recall for further tests and cancer detection. Differences in positive predictive value (PPV) were assessed using Pearson's chi-squared test. RESULTS: When reader 1 recalls, the probability of reader 2 also recalling was higher when not blinded than when blinded, suggesting readers may be influenced by the other's decision. Overall, women were less likely to be recalled when reader 2 was blinded (OR 0.923; 95% credible interval 0.864, 0.986), with no clear pattern in cancer detection rate (OR 1.029; 95% credible interval 0.970, 1.089; Bayesian p value 0.832). PPV was 22.1% for blinded versus 20.6% for not blinded (p < 0.001). CONCLUSIONS: Our results suggest that when not blinded, reader 2 is influenced by reader 1's decisions to recall (alliterative bias) which would result in bypassing arbitration and negate some of the benefits of double-reading. We found a relationship between blinding the second reader and slightly higher PPV of breast cancer screening, although this analysis may be confounded by other centre characteristics. KEY POINTS: • In Europe, it is recommended that breast screening mammograms are analysed by two readers but there is little evidence on the effect of 'blinding' the readers so they cannot see each other's decisions. • We found evidence that when the second reader is not blinded, they are more likely to agree with a recall decision from the first reader and less likely to make an independent judgement (alliterative error). This may reduce overall accuracy through bypassing arbitration. • This observational study suggests an association between blinding the second reader and higher positive predictive value of screening, but this may be confounded by centre characteristics.
dc.languageen
dc.publisherSpringer Science and Business Media LLC
dc.subjectBreast
dc.subjectBreast neoplasms
dc.subjectMammography
dc.subjectMass screening
dc.subjectEarly detection of cancer
dc.subjectMarkov chains
dc.titleOptimising breast cancer screening reading: blinding the second reader to the first reader's decisions.
dc.typeArticle
dc.date.updated2022-01-04T11:58:50Z
prism.endingPage612
prism.issueIdentifier1
prism.publicationNameEur Radiol
prism.startingPage602
prism.volume32
dc.identifier.doi10.17863/CAM.79300
dcterms.dateAccepted2021-03-30
rioxxterms.versionofrecord10.1007/s00330-021-07965-z
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
dc.contributor.orcidTaylor-Phillips, Sian [0000-0002-1841-4346]
dc.identifier.eissn1432-1084
pubs.funder-project-idNational Institute for Health Research (NIHRDH-IS-BRC-1215-20014)
cam.issuedOnline2021-06-12


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