Performance Metrics of Mammography Screening Programmes in Primary Health Care Centres in Bahrain.

Background: Mammography is the cornerstone of breast cancer screening. Its diagnostic performance, however, is influenced by population demographics such as age and breast density. Purpose: The aim of this study was to establish contemporary performance benchmarks for mammography screening in Bahrain's primary health-care centres (PHCs) and to identify areas for quality improvement. Methods: A cross-sectional retrospective analysis was performed on mammograms from asymptomatic women aged ≥40 years who were screened in 2020 at primary health care centres. Screening outcomes were cross-referenced with subsequent breast cancer diagnoses recorded in the Bahrain Cancer Registry (2021-2022). Mammographic findings were categorised using the Breast Imaging Reporting and Data System (BI-RADS), and performance metrics including the cancer detection rate (CDR), sensitivity, and specificity were calculated. Results: A total of 2196 screening mammograms were included, with a mean patient age of 56.1 years. The cancer detection rate was 12.3 per 1000 screens, and the recall rate was 30.6%. Sensitivity and specificity were 69.2% and 71.2%, respectively, and the interval cancer rate was 5.4 per 1000. The most common breast density category was "scattered fibroglandular" (61.8%). Recall rates were significantly associated with breast density (p < 0.001). Among the 39 patients diagnosed with breast cancer, invasive ductal carcinoma was the most prevalent subtype (71.8%). Conclusion: The findings highlight the moderate utility of mammography screening in Bahrain, characterised by a relatively high recall rate and a need to optimise reporting standards and recall criteria. Tailored strategies such as supplemental imaging for women with dense or high-risk breasts, strict adherence to BI-RADS guidelines, and implementing double reading or single reading with computer-aided detection could improve screening outcomes. These results establish important regional performance benchmarks and can inform policies to enhance breast cancer detection and management in the Arabian Gulf region.