The purpose of the study was to compare the performance of full-field digital mammography (FFDM) with soft-copy reading to screen film mammography (SFM) used during the first prevalent 2-year round of population-based screening. A total of 18,239 women aged 50-69 years were screened with FFDM as part of the Norwegian Breast Cancer Screening Programme (NBCSP). Process indicators were compared to data from 324,763 women screened with SFM using the common national database of the NBCSP. The cancer detection rates were 0.77% (140/18,239) for FFDM and 0.65% (2,105/324,763) for SFM (p = 0.058). For ductal carcinoma in situ (DCIS) alone, the results were: FFDM 0.21% (38/18,239) compared to SFM 0.11% (343/324,763) (p < 0.001). Recall rates due to positive mammography were for FFDM 4.09% (746/18,239), while for SFM 4.16% (13,520/324,764) (p = 0.645), due to technically insufficient imaging: FFDM 0.22% (40/18,239) versus SFM 0.61% (1,993/324,763) (p < 0.001). The positive predictive value (PPV) in the FFDM group was 16.6% (140/843), while 13.5% (2,105/15,537) for SFM (p = 0.014). No statistically significant differences were recorded concerning histological morphology, tumour size, or lymph node involvement. In conclusion FFDM had a significantly higher detection rate for DCIS than SFM. For invasive cancers no difference was seen. FFDM also had a significantly higher PPV and a significantly lower technical recall rate.

Secondary tumours in the breast are rare. Based on literature, an incidence of 0.4-2% is reported. In this population-based study, secondary breast tumours from a 5-year period (2001-2005), not including metastasis from contralateral breast carcinoma, were reviewed (Vestfold County, Norway). A total of 722 patients with breast malignancies were found in this population (89.3% from Vestfold County Hospital). Ten of these, approximately 1.4%, were metastatic tumours, representing four cutaneous melanomas, three pulmonary carcinomas and three malignant lymphomas. The tumours were often solitary, palpable and close to the skin. Radiologically, the lesions mostly resembled primary carcinomas by mammography and ultrasound, which differs from other studies. Comparison with a known primary tumour and use of immunohistochemical profiling is of crucial importance. Melanoma markers (Melan-A, HMB-45, S-100 protein), lung cancer markers (Cytokeratins, TTF1, Chromogranin, Synapthophysin) and lymphoid markers (CD3, CD20) usually help to confirm a secondary breast tumour diagnosis. This approach is especially indicated in diffusely growing tumours with lack of glandular structure and high-grade cytological features, and staining for ER and GCDFP15 may be helpful. Thus, the diagnosis of a breast metastasis may be suspected by careful mammography and ultrasound imaging, although some cases have atypical radiological features, and histological examination might be necessary to ensure a correct diagnosis and appropriate treatment.

From 1930 to 1990 annual age-adjusted breast cancer death rates for women in the United States remained remarkably constant, oscillating around 32 deaths per 100,000 over 60 years. During this long timeframe, the surgical treatment of breast cancer evolved from radical mastectomy with mandatory lymph node dissection to lumpectomy coupled with radiation therapy. With this new paradigm, lymph node dissection was reserved for women with tumor-invaded axillary lymph nodes. Beginning in the 1970s, chemotherapy after surgery (adjuvant) and before surgery (neoadjuvant) was added to surgical treatment. The radical diminution in the scope of breast surgery did not alter the national breast cancer death rate. Doing less surgery was neither harmful nor beneficial to long-term survival from breast cancer. In the 1980s two events changed this static picture: the addition of tamoxifen to adjuvant and neoadjuvant chemotherapy, and the introduction of mammography. Beginning in 1990 annual breast cancer death rates in the United States began to fall, and have continued to fall each year since then. In 2001, the last year of published statistics, the breast cancer death rate was 26 deaths per 100,000. Best estimates for where to credit this dramatic drop in death rate place approximately 50% of the credit with improved adjuvant chemotherapy and 50% with mammography. Abnormal mammograms demand a breast biopsy since only one in five abnormal mammograms is actually a breast cancer. Consequently, widespread adoption of mammography has produced an image-guided breast biopsy industry in the United States. Open, surgical breast biopsy has been replaced with image-guided breast biopsy because improved breast biopsy tools have made image-guided breast biopsy equivalent in accuracy to open, surgical breast biopsy. These tools, in turn, have changed the professional lives of surgeons, pathologists, and mammographers, leading to the development of dedicated breast surgeons, breast pathologists, and interventional breast radiologists.