How does not having a breast screening program affect a country’s radiologists?

There are large differences in the mammographic performance of radiologists from countries with breast cancer screening programs and countries without such programs, according to a new study published in Academic Radiology.

“Mammographic screening (MS) has been confirmed as an effective approach to detecting most breast cancers at a preclinical stage and therefore results in mortality reduction,” wrote lead author Delgermaa Demchig, MD, of the University of Sydney in New South Wales, Australia, and colleagues. “However, the level of MS implementation among nonscreening (NS) countries varies largely, resulting from limited economic resources, inadequate health infrastructure and low incidence settings.”

Demchig et al. compared the mammographic performance of radiologists in a NS country with radiologists from Australia, where specialists practice biennial MS. Two mammographic test sets were used for the study: a typical screening (TS) set and a high-difficulty (HD) set. The authors noted that the differences in performance existed when radiologists were reading both the TS and the HD set.

Significant differences were observed in case sensitivity, specificity, locational sensitivity, receiver operating characteristics, area under the curve and jack-knife free-response receiver operating characteristics.

“These data provide more evidence that there is a substantial variation in diagnostic performance between readers from NS and screening countries,” the authors wrote. “This suggests the need for initiating a strategic solution in these countries in order to maximize the detection of early breast cancers.”

Demchig and colleagues added that training is considerably different between the two countries being compared, which could affect mammographic performance.

“It should be acknowledged that medical training for these two countries differ greatly,” they wrote. “For example, in the NS country, radiologists have to be a graduate of a 6-year medical university with a subsequent 2-year radiology residency training. This is in contrast to Australia, where, to become a radiologist, one must complete 4–6 years of medical school with a subsequent 5-year postgraduate radiology education.”