Radiologists can detect the ‘gist’ of breast cancer before any overt signs of cancer appear

Radiologists can detect abnormality in mammograms at above-chance levels after a momentary glimpse of an image. The study investigated this instantaneous perception of an abnormality, known as a “gist” response, when 23 radiologists viewed prior mammograms of women that were reported as normal, but later diagnosed with breast cancer at subsequent screening. Five categories of cases were included: current cancer-containing mammograms, current mammograms of the normal breast contralateral to the cancer, prior mammograms of normal cases, prior mammograms with visible cancer signs in a breast from women who were initially reported as normal, but later diagnosed with breast cancer at subsequent screening in the same breast, and prior mammograms without any visible cancer signs from women labelled as initially normal but subsequently diagnosed with cancer. Our findings suggest that readers can distinguish patients who were diagnosed with cancer, from individuals without breast cancer (normal category), at above-chance levels based on a half-second glimpse of the mammogram even before any lesion becomes visible on the mammogram. Although 20 of the 23 radiologists demonstrated this ability, radiologists’ abilities for perceiving the gist of the abnormal varied between the readers and appeared to be linked to expertise. These results could have implications for identifying women of higher than average risk of a future malignancy event, thus impacting upon tailored screening strategies.