From training to audit

Breast cancer screening helps reduce mortality through early detection, with mammography remaining the most effective screening method. However, screening also carries potential drawbacks, including false-positive recalls and overdiagnosis. The screening performance of radiologists plays an important role in balancing these benefits and harms. This thesis examines factors that may improve screening performance, including training, recall strategies and audit procedures. A literature review showed that radiologist training generally leads to performance improvement, despite methodological variation. An evaluation of well circumscribed masses—common causes of false-positive recalls—suggested that access to prior clinical mammograms may enhance recall decision-making, particularly at first screening examinations. A prospective study demonstrated that warning signals from radiographers increased recall rates without improving detection, indicating that such warning signals may be more effective when presented only after the radiologist’s initial decision. Analysis of audit data revealed improvements in detection and sensitivity over time and highlighted the value of radiological review and immediate feedback. Finally, PPV–recall diagrams proved useful for monitoring screening performance, although additional individual feedback may be required. Taken together, the findings underscore the complexity of interpreting mammograms and offer recommendations for improving radiological performance.