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UKCCCR multicentre randomised controlled trial of one and two view mammography in breast cancer screening

^a Cancer Research Campaign, Cancer Screening research Group, Wolfson Institute of Preventive Medicine, St Bartholomew's Hospital Medical College, London EC1M 6BQ, ^b Medical Research Council Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, St Bartholomew's Hospital Medical College, London EC1M 6BQ

The trial collaborators who read the mammograms in the trial and the centres that took part are listed at the end of this paper.Correspondence to: Professor Wald.

Abstract

Objective: To compare one view (oblique) and two view (oblique and craniocaudal) mammography in breast cancer screening.
Design: Randomised controlled trial.
Setting: Nine breast screening centres in England.
Subjects: 40163 women aged 50-64 attending their first breast screening examination.
Interventions: Women were randomised to have one view mammography, two view mammography, or two view mammography in which one view was read by one reader and both views were read by another.
Main outcome measures: Prevalence of cancer detected, recall rates, cost per cancer detected, and marginal cost per extra cancer detected.
Results: Two view mammography detected 24% more women with breast cancer (95% confidence interval 16% to 31%) than one view mammography. Prevalence of detected cancer was 6.84 with two view mammography and 5.52 per 1000 women with one view. The proportion of women recalled for assessment was 15% lower (95% confidence interval 6% to 23%) with two view (6.97%) than with one view (8.16%) mammography. The cost of two view screening was higher (pounds sterling26.46 compared with pounds sterling22.00 per examination) but the average cost per cancer detected was similar (pounds sterling5330 compared with pounds sterling5310) and the marginal cost per extra cancer detected with two views was similar to the average cost (pounds sterling5400).
Conclusion: Two view mammography is medically more effective than one view; it detects more cancers and reduces recall rates; it is also similarly cost effective financially.

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