# Surgical and Radiology Trainees’ Proficiency in Reading Mammograms: the Importance of Education for Cancer Localisation

## TL;DR

This study compares the ability of surgical and radiology trainees to identify breast cancers in mammograms and highlights the value of simulated training for improving cancer detection skills.

## Contribution

The study introduces a simulated testing platform (BREAST) to assess and enhance trainees' proficiency in mammogram interpretation.

## Key findings

- Radiology trainees had significantly higher specificity than surgical trainees (0.72 vs. 0.35).
- No significant differences were found in sensitivity or lesion sensitivity between the two groups.
- Higher breast density cases were associated with lower overall performance.

## Abstract

Medical imaging with mammography plays a very important role in screening and diagnosis of breast cancer, Australia’s most common female cancer. The visualisation of cancers on mammograms often forms a diagnosis and guidance for radiologists and breast surgeons, and education platforms that provide real cases in a simulated testing environment have been shown to improve observer performance for radiologists. This study reports on the performance of surgical and radiology trainees in locating breast cancers. An enriched test set of 20 mammography cases (6 cancer and 14 cancer free) was created, and 18 surgical trainees and 32 radiology trainees reviewed the cases via the Breast Screen Reader Assessment Strategy (BREAST) platform and marked any lesions identifiable. Further analysis of performance with high- and low-density cases was undertaken, and standard metrics including sensitivity and specificity. Radiology trainees performed significantly better than surgical trainees in terms of specificity (0.72 vs. 0.35; P < 0.01). No significant differences were observed between the surgical and radiology trainees in sensitivity or lesion sensitivity. Mixed results were obtained with participants regarding breast density, with higher density cases generally having lower performance. The higher specificity of the radiology trainees compared to the surgical trainees likely represents less exposure to negative mammography cases. The use of high-fidelity simulated self-test environments like BREAST is able to benchmark, understand and build strategies for improving cancer education in a safe environment, including identifying challenging scenarios like breast density for enhanced training.