The Role of Artificial Intelligence in Breast Cancer Screening Programmes: A Literature Review and Focus Upon Policy Implications

Abstract

Background: Breast cancer (BC) is a leading cause of morbidity and mortality amongst older women, leading to the introduction of screening programmes to support earlier detection and improved survivability. Current screening programmes rely upon the performance of radiologists in terms of accuracy; however, evidence shows that both under and overdiagnosis means screening also results in harms to some women. Artificial intelligence is then a promising technology for improving the accuracy of mammogram screening.

Aim: To describe the potential roles of AI in BC screening, and the potential benefits, limitations and risks in these roles.

Methods: PubMed, SCOPUS, and CINAHL were searched. Primary research studies published in English and in the last ten years, investigating the accuracy of AI systems for screening BC, were eligible for review. Evidence was appraised using the CASP (2024) checklists and data analysed narratively.

Results: 14 studies were found eligible for review, mostly adopting a retrospective study design or laboratory study design. Roles for AI in BC screening include as a standalone system replacing radiologists entirely, as risk stratification systems used before radiologist readings, or as reader aids. While some studies reported AI systems to be superior, others reported accuracy to be inferior to radiologist readings. Differences in results could be due to variations in AI system or radiologist performance.

Conclusion: There is insufficient evidence to support the use of AI in BC screening programmes, and more robust, prospective studies comparing readings from clinical practice are urgently required. Policy must also be implemented to regulate the use of AI until there is sufficient evidence to support its use.