Optimum screening mammography reading volumes: evidence from the NHS Breast Screening Programme

Eleanor Cornford*, Shan Cheung, Mike Press, Olive Kearins, Sian Taylor-Phillips

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: Minimum caseload standards for professionals examining breast screening mammograms vary from 480 (US) to 5000 (Europe). We measured the relationship between the number of women’s mammograms examined per year and reader performance. 

Methods: We extracted routine records from the English NHS Breast Screening Programme for readers examining between 1000 and 45,000 mammograms between April 2014 and March 2017. We measured the relationship between the volume of cases read and screening performance (cancer detection rate, recall rate, positive predictive value of recall (PPV) and discrepant cancers) using linear logistic regression. We also examined the effect of reader occupational group on performance. 

Results: In total, 759 eligible mammography readers (445 consultant radiologists, 235 radiography advanced practitioners, 79 consultant radiographers) examined 6.1 million women’s mammograms during the study period. PPV increased from 12.9 to 14.4 to 17.0% for readers examining 2000, 5000 and 10000 cases per year respectively. This was driven by decreases in recall rates from 5.8 to 5.3 to 4.5 with increasing volume read, and no change in cancer detection rate (from 7.6 to 7.6 to 7.7). There was no difference in cancer detection rate with reader occupational group. Consultant radiographers had higher recall rate and lower PPV compared to radiologists (OR 1.105, p = 0.012; OR 0.874, p = 0.002, unadjusted). 

Conclusion: Positive predictive value of screening increases with the total volume of cases examined per reader, through decreases in numbers of cases recalled with no concurrent change in numbers of cancers detected. 

Key Points: • In the English Breast Screening Programme, readers who examined a larger number of cases per year had a higher positive predictive value, because they recalled fewer women for further tests but detected the same number of cancers. • Reader type did not affect cancer detection rate, but consultant radiographers had a higher recall rate and lower positive predictive value than consultant radiologists, although this was not adjusted for length of experience.

Original languageEnglish
Pages (from-to)6909-6915
Number of pages7
JournalEuropean Radiology
Issue number9
Early online date25 Feb 2021
Publication statusPublished - Sept 2021

Bibliographical note

Funding Information: The analysis for this study was undertaken by Public Health England staff as part of the quality assurance function of the NHS Breast Screening Programme. STP is funded by the NIHR through a career development fellowship (NIHR-CDF-2016-09-018). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Open Access: No Open Access licence.

Publisher Copyright: © 2021, European Society of Radiology.

Citation: Cornford, E., Cheung, S., Press, M. et al. Optimum screening mammography reading volumes: evidence from the NHS Breast Screening Programme. Eur Radiol 31, 6909–6915 (2021).

DOI: https://doi.org/10.1007/s00330-021-07754-8


  • Breast
  • Breast cancer
  • Mammography
  • Mass screening


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