European guidelines on breast cancer screening and diagnosis

How should a breast cancer screening programme be implemented?

As an organised screening programme for early detection of breast cancer in women who do not have symptoms of breast cancer, as recommended by the ECIBC's Guidelines Development Group (GDG).

Within an organised screening programme, how should mammograms be read?

Radiologists should read between 3,500 and 11,000 mammograms annually and use double reading.

If you live in a country with an organised screening programme, you might be invited to screening. If you receive an invitation, you can speak with your healthcare professional about the benefits and harms of attending screening.

Within an organised screening programme, more women are likely to be correctly diagnosed and fewer told they have breast cancer when in reality they do not.

Using double reading, that is a mammogram read independently by two radiologists, in an organised screening programme probably finds slightly more breast cancers, and slightly decreases the number of cancers diagnosed with symptoms in the interval between the scheduled screening appointments. Also, probably slightly more women are correctly diagnosed (when using double reading).

Double reading may slightly increase the chances of receiving a false positive screening result, which means a woman would have further tests after screening. These tests will confirm that she does not have cancer, but she may have suffered unnecessary anxiety and distress.

In addition, when radiologists read between 3,500 and 11,000 mammograms annually, there may be more women correctly diagnosed and fewer women told they have breast cancer when in reality they do not. However, the evidence is very uncertain.

The GDG noted that the costs would be higher when using double reading and that the availability of specialist training varies according to the country.

Organised screening is a type of screening programme where additional procedures (e.g. standard operating procedures) are specified and where a team at national or regional level is responsible for implementing the policy, i.e. for coordinating the delivery of screening services, maintaining requisite quality, and reporting on performances and results.

Opportunistic or non-organised screening refers to all other screening where examinations for early detection of cancer are performed in a diagnostic or clinical setting, independent from the public screening policy (if existing).

Double reading refers to mammograms been read, generally independently, by two radiologists. If there is disagreement about the result, these mammograms can be reviewed by a third radiologist (arbitration) or can be discussed by the two radiologists to reach consensus.