Really excited 🥳 to share two breast cancer AI papers from my time at Google, published jointly in Nature Cancer today!
We set out in 2021 to answer a question that matters to millions of women: can AI safely improve breast cancer screening in the NHS? Five years, five organisations, and 125,000 women’s scans later, here's what we found.
1️⃣ Our first paper (
nature.com/articles/s43018-0…) evaluated Google's mammography AI across five NHS screening services, with 39-month follow-up including interval next-round cancers:
→ AI achieved superior sensitivity to human readers (54% vs 44%, P<0.001) with non-inferior specificity
→ 25% of future interval next-round cancers detected = potential for earlier diagnosis
→ Reading time reduced by 32% while cancer detection increased by 18%
→ No systematic disparities across age, ethnicity, deprivation, or breast density
→ Prospective deployment at 12 sites confirmed feasibility but revealed distribution shift requiring recalibration - a critical lesson for implementation
2️⃣ Our second paper (
nature.com/articles/s43018-0…) tackled what happens when AI becomes the second reader. When readers disagree today, a specialist panel "arbitrates". We studied 50,000 women's screens with 22 readers, with and without AI as the second reader:
→ End-to-end including arbitration, our AI-enabled arm was non-inferior to standard double reading (P<0.001)
→ Human reading workload reduced by 46%
→ AI flagged far more interval next-round cancers before arbitration, but many were overruled, even when the AI correctly localised the cancer
→ Future: better explainability, prior image integration, reader training, and new pathways to maximise AI success (e.g. supplemental imaging for high risk normal cases)
An editorial from Allan Hackshaw and Rosalind Given-Wilson (
nature.com/articles/s43018-0…) covers this work really well - thank you!
Conclusion: The AI works, and it can find cancers earlier. But how we integrate it into clinical workflows will determine whether that potential translates into better outcomes for women.
This collaboration between
@GoogleResearch,
@imperialcollege,
@RoyalSurrey, @stgeorgeshospital, St George's University Hospitals NHS Foundation Trust, and Imperial College Healthcare NHS Trust was funded by the NHS AI Award. We are deeply grateful to everyone involved. Thank you to @skourti_elena at Nature Cancer.
Congratulations Lucy Warren, Marc Wilson, Jenny Venton, Ken Young, Mark Halling-Brown, Megumi Morigami, Lisanne Khoo, Deborah cunningham, Richard Sidebottom, Reddy Mamatha, Hema Purushothaman, Delara Khodabakhshi, Lesley Honeyfield, Amandeep Hujan, Tsvetina Stoycheva, Andy Joiner, Reena Chopra, Aminata Sy, Dominic Ward, Lin Yang, Rory Sayres, Daniel Golden, Namrata Malhotra, Rachita Mallya, Lihong Xi, Della Ogunleye, Charlotte Purdy, Alistair Mackenzie, Jane Chang, Jonathan Dixon, Elzbieta Gruzewska, Emma Lewis, Marcin Sieniek, Shawn Xu,
@DrSusanThomas,
@shravyas,
@fjg28_fiona,
@Ara_Darzi, Hutan Ashrafian 🎉