Detecting the “gist” of breast cancer in mammograms three years before localized signs of cancer are visible

Karla Evans, Anne-Marie Kulpan, Jeremy Wolfe

Research output: Contribution to journalArticlepeer-review


Objectives: After a 500 ms presentation, experts can distinguish abnormal mammograms at above chance levels even when only the breast contralateral to the lesion is shown. Here, we show that this signal of abnormality is detectable 3 years before localized signs of cancer become visible. Methods: In 4 prospective studies, 59 expert observers from 3 groups viewed 116–200 bilateral mammograms for 500 ms each. Half of the images were prior exams acquired 3 years prior to onset of visible, actionable cancer and half were normal. Exp. 1D included cases having visible abnormalities. Observers rated likelihood of abnormality on a 0–100 scale and categorized breast density. Performance was measured using receiver operating characteristic analysis. Results: In all three groups, observers could detect abnormal images at above chance levels 3 years prior to visible signs of breast cancer (p < 0.001). The results were not due to specific salient cases nor to breast density. Performance was correlated with expertise quantified by the number of mammographic cases read within a year. In Exp. 1D, with cases having visible actionable pathology included, the full group of readers failed to reliably detect abnormal priors; with the exception of a subgroup of the six most experienced observers. Conclusions: Imaging specialists can detect signals of abnormality in mammograms acquired years before lesions become visible. Detection may depend on expertise acquired by reading large numbers of cases. Advances in knowledge: Global gist signal can serve as imaging risk factor with the potential to identify patients with elevated risk for developing cancer, resulting in improved early cancer diagnosis rates and improved prognosis for females with breast cancer.
Original languageEnglish
Article number20190136
Number of pages10
JournalThe British Journal of Radiology
Issue number1099
Early online date5 Jun 2019
Publication statusPublished - 13 Jun 2019


  • Adult
  • Aged
  • Breast Neoplasms/diagnostic imaging
  • Breast/diagnostic imaging
  • Early Detection of Cancer/methods
  • Female
  • Humans
  • Mammography/methods
  • Middle Aged
  • Prospective Studies
  • Sensitivity and Specificity

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