{"entity":{"id":"idea-prev-mammography-ai-stepped-wedge","kind":"idea","name":"Roll out AI-supported mammography nationally as a stepped-wedge trial","aka":[],"tldr":"Sweden's MASAI trial showed AI can safely replace one of two radiologists. Rolling it out region by region in a randomised order would prove it works at national scale and that interval cancers do not rise.","summary":"MASAI (Lund) demonstrated a 44% workload reduction and higher cancer detection with AI-supported reading. Rather than piecemeal adoption, propose national programmes adopt in a randomised stepped-wedge order so every region serves as its own control, with interval cancer rate and recall rate as co-primary endpoints.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022)","url":"https://doi.org/10.1126/science.aay9040"}],"tags":[],"related":[],"cancers":["breast-hr-positive"],"sections":["early-detection","imaging"],"technologies":["mammography","radiology-ai-screening"],"targets":[],"drugs":[],"companies":["lunit"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-workforce"],"keyPapers":["paper-crosby-science"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"National AI-supported reading reduces radiologist reading load by at least 40% with no increase in interval cancers and no increase in DCIS-only detection.","rationale":"Stepped-wedge gives regulator-grade evidence at the cost of an implementation programme, and detects harms (recall, DCIS inflation) that single-centre trials cannot.","test":"Run a three-year stepped-wedge across about ten regions of a national programme with a pre-registered analysis.","maturity":"being-tested-at-scale","actor":"policy","cost":"medium","horizonYears":4},"route":"/ideas/idea-prev-mammography-ai-stepped-wedge/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"imaging","kind":"section","name":"Imaging","route":"/fronts/imaging/"}],"technology":[{"id":"radiology-ai-screening","kind":"technology","name":"AI in radiology","route":"/technologies/radiology-ai-screening/"},{"id":"mammography","kind":"technology","name":"Mammography & tomosynthesis","route":"/technologies/mammography/"}],"company":[{"id":"lunit","kind":"company","name":"Lunit","route":"/companies/lunit/"}],"bottleneck":[{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"paper":[{"id":"paper-crosby-science","kind":"paper","name":"Early detection of cancer","route":"/key-papers/paper-crosby-science/"},{"id":"paper-masai-lancet-oncol-2023","kind":"paper","name":"MASAI: AI-supported mammography screening finds more cancers with half the radiologist workload","route":"/key-papers/paper-masai-lancet-oncol-2023/"}]}}