Impact of using artificial intelligence as a second reader in breast screening including arbitration
Lucy M. Warren, Jenny Venton, Kenneth C. Young, Mark Halling‐Brown, Christopher J. Kelly, Marc Wilson, Megumi Morigami, Lisanne A. L. Khoo, Deborah Cunningham, Richard A. Sidebottom, Mamatha Reddy, Hema Purushothaman, Delara Khodabakhshi, Lesley Honeyfield, Amandeep Hujan, Tsvetina Stoycheva, Andy Joiner, Reena Chopra, Aminata Sy, Dominic Ward · Nature Cancer · 2026
The impact of incorporating artificial intelligence (AI) into a double-read breast-screening workflow, including arbitration, is unclear. This retrospective study included 50,000 representative women from two NHS breast-screening centers. All the women had long-term follow-up, allowing us to determine whether use of AI leads to earlier cancer detection. Cases requiring arbitration (8,732 cases) were read by 22 readers in a reader study, following their normal arbitration workflow. Overall, after arbitration, replacing the second reader with AI was noninferior (5% margin) to two human readers in terms of sensitivity and specificity (P < 0.001) while offering a workload benefit. Arbitration improved the specificity of the AI arm by overruling cases incorrectly recalled by the AI tool; however, it also overruled the AI tool recall decision for some interval and next-round cancers. Further development of the AI tool alongside improvement in its explainability could lead to the earlier detection of cancers.