乳腺癌筛查准确度不会随着乳房钼靶筛查评估时间增加而下降
2016年5月10日，《美国医学会杂志》（JAMA）发表了英国华威大学沃里克医学院、英国国家卫生研究所剑桥生物医学研究中心、英国剑桥大学医院、英国诺丁汉西顿之家筛查质量保证服务机构、英国考文垂和沃里克大学医院沃里克、索利哈尔和考文垂乳腺筛查服务机构、英国伦敦皮尔和斯瑞克咨询有限公司的研究报告，发现解读乳房钼靶摄影筛查的读片者花更长时间并不会导致乳腺癌检测率减少。
对乳房钼靶筛查的解读是一项困难而且重复性的视觉搜寻工作，因为癌症特征可在乳腺实质（乳腺组织）背景中被隐藏，从而导致假阳性召回和癌症漏诊。在类似的视觉搜索作业中，警戒递减现象（即随着作业时间的推移而检测率下降）在大量的心理学实验室试验中被观察到，其中包括装配生产线检验作业和机场行李筛查。在该研究中，每两位读片者对每个乳房钼靶筛查进行了癌症迹象的独立评估。
该研究对乳腺癌筛查中是否存在发现癌症的警戒递减进行了检验，他们还对改变每两位专家检验一批乳房钼靶筛查的顺序是否增加癌症的检测率进行了检验，尽管在检验不同女性的乳房钼靶筛查时，读片者在不同时间点所经历的巅峰警戒性处于阅读该乳房钼靶筛查的时间内。
该研究在来自英国的国家医疗服务（NHS）乳腺筛查计划46个乳腺筛查中心开展，时间为期1年。360位读片者参加了研究，他们都具有在NHS乳腺筛查计划中做出乳房钼靶筛查报告的完整资格。在对照组中，每两位读片者以相同的顺序对每批数码乳房钼靶筛查进行了检验，而在干预组中则以相互之间相反的顺序进行读片检验。
在1,194,147例乳房钼靶筛查女性中（干预组596,642例，对照组597,507例），37,688批（中位批次大小：35）图像接受了解读，每位读片者所解读的中位批次为176。在完成了所有后续诊断检测之后，共发现乳腺癌10,484例（0.88%）。在癌症检测率上无明显差异，干预组发现5,272例癌症（0.88%），对照组发现5,212例癌症（0.87%），召回率：4.14%比4.17%，读片者分歧率，3.43%比3.48%。
JAMA. 2016 May 10;315(18):1956-1965.
Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection: A Randomized Clinical Trial.
Taylor-Phillips S, Wallis MG, Jenkinson D, Adekanmbi V, Parsons H, Dunn J, Stallard N, Szczepura A, Gates S, Kearins O, Duncan A, Hudson S, Clarke A.
Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Cambridge Universities NHS Foundation Trust and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom.
Screening QA Service (Midland & East), Seaton House, City Link, Nottingham, United Kingdom.
Warwickshire, Solihull and Coventry Breast Screening Service, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.
Peel & Schriek Consulting Limited, London, United Kingdom.
Importance: Interpreting screening mammograms is a difficult repetitive task that can result in missed cancers and false-positive recalls. In the United Kingdom, 2 film readers independently evaluate each mammogram to search for signs of cancer and examine digital mammograms in batches. However, a vigilance decrement (reduced detection rate with time on task) has been observed in similar settings.
Objective: To determine the effect of changing the order for the second film reader of batches of screening mammograms on rates of breast cancer detection.
Design, Setting, and Participants: A multicenter, double-blind, cluster randomized clinical trial conducted at 46 specialized breast screening centers from the National Health Service Breast Screening Program in England for 1 year (all between December 20, 2012, and November 3, 2014). Three hundred sixty readers participated (mean, 7.8 readers per center)-186 radiologists, 143 radiography advanced practitioners, and 31 breast clinicians, all fully qualified to report mammograms in the NHS breast screening program.
Interventions: The 2 readers examined each batch of digital mammograms in the same order in the control group and in the opposite order to one another in the intervention group.
Main Outcomes and Measures: The primary outcome was cancer detection rate; secondary outcomes were rates of recall and disagreements between readers.
Results: Among 1,194,147 women (mean age, 59.3; SD, 7.49) who had screening mammograms (596,642 in the intervention group; 597,505 in the control group), the images were interpreted in 37,688 batches (median batch size, 35; interquartile range [IQR]; 16-46), with each reader interpreting a median of 176 batches (IQR, 96-278). After completion of all subsequent diagnostic tests, a total of 10,484 cases (0.88%) of breast cancer were detected. There was no significant difference in cancer detection rate with 5272 cancers (0.88%) detected in the intervention group vs 5212 cancers (0.87%) detected in the control group (difference, 0.01% points; 95% CI, -0.02% to 0.04% points; recall rate, 24,681 [4.14%] vs 24,894 [4.17%]; difference, -0.03% points; 95% CI, -0.10% to 0.04% points; or rate of reader disagreements, 20,471 [3.43%] vs 20,793 [3.48%]; difference, -0.05% points; 95% CI, -0.11% to 0.02% points).
Conclusions and Relevance: Interpretation of batches of mammograms by qualified screening mammography readers using a different order vs the same order for the second reading resulted in no significant difference in rates of detection of breast cancer.
Trial Registration: isrctn.org Identifier: ISRCTN46603370.
PMID: 27163985
DOI: 10.1001/jama.2016.5257