Acceptability of Using Artificial Intelligence in the National Health Service Breast Screening Program: A Randomized Online Survey of Screening-Eligible Women in England.

Objective: To compare acceptability of 2 artificial intelligence (AI) use cases in the English National Health Servic Breast Screening Program. Patients and Methods: From February 7 to March 14 2024, we conducted an online survey, randomizing participants to information about using AI either as the second mammogram reader or to triage mammograms. In the triage scenario, only higher-risk images would be reviewed by a human reader. The survey was completed by 3419 women aged 45 to 70 years, recruited from an online panel. The primary outcome was acceptability of the presented AI use case. We assessed a range of psychological and demographic factors. Regression modeling examined predictors of acceptability. Results: Using AI as a second reader was rated as more acceptable (P<.001), less concerning (P<.001), and less likely to put people off screening (P =.001) than using it as a triage tool. In both groups, most women said AI would not affect their breast screening attendance (1251/1710 [73%] and 1195/1709 [70%] in the second reader and triage groups, respectively). Nevertheless, 15% (498/3419) of participants stated that the use of AI would make them less likely to attend. After adjusting for AI use case, acceptability was higher in respondents of older age, White ethnicity, higher education, greater AI knowledge, and with more positive attitudes toward both AI and breast screening. Conclusion: Artificial intelligence in breast screening was rated as more acceptable if used alongside, rather than instead of, a human reader. Ongoing careful evaluation is needed to ensure its roll-out does not widen existing social inequalities and that the risk-benefit profile of screening is maintained.