Comparing Breast Screening Protocols: Inserting Catch Trials Does Not Improve Sensitivity over Double Screening

Abstract

Breast screening is an important tool for the early detection of breast cancers. However, tumours are typically present in less than 1% of mammograms. This low prevalence could cause radiologists to detect fewer tumours than they otherwise would, an issue known as the prevalence effect. The aim of our study was to investigate a novel breast screening protocol, designed to decrease the number of tumours missed by radiologists, without increasing their workload. We ran two laboratory-based experiments to assess the degree to which the novel protocol, called the catch trial (CT) protocol, resulted in greater sensitivity (d') than the double screener protocol (DS), currently utilised in Australia. In our first experiment we found evidence that the CT protocol resulted in a criterion shift relative to the DS protocol but the evidence that sensitivity was greater in the CT protocol relative to the DS protocol was less clear. A second experiment, using more realistic stimuli that were more representative of actual tumours, also failed to find convincing evidence that sensitivity was greater in the CT protocol than in the DS protocol. This experiment instead found that both the hit rate and the false alarm rate increased in the CT protocol relative to the DS protocol. So while there was again evidence that the CT protocol induced a criterion shift, the sensitivity appeared to be approximately the same in both protocols. Our results suggest the CT protocol is unlikely to result in an improvement in sensitivity over the DS protocol, so we cannot recommend that it be trialled in a clinical setting.