Improving the detection of early breast cancer by UK radiologists

One in eight women will get breast cancer. Each year, more than two million women in the UK attend mammography screening appointments – about eight cancer cases for every 1,000 women tested are detected.

The low incidence makes it difficult for radiologists to detect cancer accurately. Our research has detailed key visual mammographic image features which underpin radiologists’ ability to identify early signs of cancer.

These findings underpin an online self-assessment training tool – PERFORMS. Funded by the NHS Breast Screening programme and implemented nationally by Public Health England in 2015, it is mandated for every UK practitioner and endorsed as CPD by the Royal College of Radiologists.

Its impact extends into the US, Australia, Belarus, Israel, and several EU countries via partners including the World Health Organization.

Our impact

International adoption

  • PERFORMS is a requirement for all screening mammography readers in the NHS Breast Screening Programme Quality Assurance Guidelines for Breast Cancer Screening Radiology.
  • The reach of the programme has been extended internationally to countries that do not typically have a national screening programme – including Australia, Belarus, the USA, Poland and elsewhere across Europe.

Award-winning technology

PERFORMS has been recognised by several accolades, including

  • The Cum Laude Prize for best research (2004, 2005, 2007 and 2012).
  • The Lord Stafford Award for Innovation Achieved (finalist, 2010).
  • The President’s Medal, Institute of Ergonomics & Human Factors (2010).
  • Loughborough University’s Enterprise Awards for Consultancy Enterprise (2009), Knowledge Transfer (2013), and the Highly Commended Award for Social and Cultural Impact (2015).

The research

We have been conducting research in this area for more than 30 years – verifying the key mammographic features that radiologists must identify to determine the presence of cancer.

Our work underpins PERFORMS – the national on-line Breast Cancer Self-Assessment and Training tool that improves radiologists’ skills in identifying cancer’s early signs.

In addition to our work around feature identification, PERFORMS draws on several of our other areas of expertise to help understand how early signs go undetected, and improve performance.

For example, our research in the use of eye-tracking in image perception confirmed that radiologist errors tend to occur in either the discovery or the recognition phase. This allows PERFORMS to critically investigate underperforming individuals.

We developed a novel approach to accurate error estimation that compares areas of interest highlighted by expert radiologists and those indicated by PERFORMS users. Our best-fit-error-margin algorithm helps clarify some of the reasons for errors when difficult cases are examined.

PERFORMS is improving and maintaining radiologists’ screening performance – saving lives.

PERFORMS has improved the education of our readers... It is an essential part of our work in delivering a quality breast screening service.

Julietta Patnick Former Director of Cancer Screening Programmes - Public Health England

At 32 years, PERFORMS is the longest running NHS-funded project of its kind

Research funders

  • NHS Breast Screening Programme
  • Public Health England

Development partners

  • NHS Breast Screening Programme
  • Public Health England
  • MyPeBS Personalised Breast Screening - EU H2020 Research Project
  • World Health Organisation

Meet the experts

Photograph of Alastair Gale

Professor Alastair Gale

Emeritus Professor of Applied Vision Sciences

Photograph of Yen Chan

Dr Yan Chen

Associate Professor in Cancer Screening - The University of Nottingham