Comparative Effectiveness of Digital Versus Film-Screen Mammography in Community Practice in the United States

Abstract

Background Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice. Objective To determine whether the interpretive performance of digital and film-screen mammography differs. Design Prospective cohort study. Setting Mammography facilities in the Breast Cancer Surveillance Consortium. Participants 329 261 women aged 40 to 79 years underwent 869 286 mammograms (231 034 digital; 638 252 film-screen). Measurements Invasive cancer or ductal carcinoma in situ diagnosed within 12 months of a digital or film-screen examination and calculation of mammography sensitivity, specificity, cancer detection rates, and tumor outcomes. Results Overall, cancer detection rates and tumor characteristics were similar for digital and film-screen mammography, but the sensitivity and specificity of each modality varied by age, tumor characteristics, breast density, and menopausal status. Compared with film-screen mammography, the sensitivity of digital mammography was significantly higher for women aged 60 to 69 years (89.9% vs. 83.0%; P = 0.014) and those with estrogen receptor-negative cancer (78.5% vs. 65.8%; P = 0.016); borderline significantly higher for women aged 40 to 49 years (82.4% vs. 75.6%; P = 0.071), those with extremely dense breasts (83.6% vs. 68.1%; P= 0.051), and pre- or perimenopausal women (87.1% vs. 81.7%; P = 0.057); and borderline significantly lower for women aged 50 to 59 years (80.5% vs. 85.1%; P = 0.097). The specificity of digital and film-screen mammography was similar by decade of age, except for women aged 40 to 49 years (88.0% vs. 89.7%; P< 0.001). Limitation Statistical power for subgroup analyses was limited. Conclusion Overall, cancer detection with digital or film-screen mammography is similar in U.S. women aged 50 to 79 years undergoing screening mammography. Women aged 40 to 49 years are more likely to have extremely dense breasts and estrogen receptor-negative tumors; if they are offered mammography screening, they may choose to undergo digital mammography to optimize cancer detection. Primary Funding Source National Cancer Institute.

Mammographic Performance in a Population-based Screening Program: Before, during, and after the Transition from Screen-Film to Full-Field Digital Mammography

“…The reported recall rates for FFDM compared with those for SFM have varied widely (3,5). Although authors of some studies report a higher rate of screening-detected invasive breast cancer for FFDM (2,(8)(9)(10), other study authors report lower (11) or similar rates for FFDM compared with SFM (12,13). Similarly, conflicting results have been published for the rate of screening-detected ductal carcinoma in situ (DCIS) and the positive predictive value (PPV) of FFDM versus SFM (2,(8)(9)(10)(11)(12).…”

Benefits and Harms of Screening Mammography by Comorbidity and Age: A Qualitative Synthesis of Observational Studies and Decision Analyses

“…However, the evidence has shown similar cancer detection rates with digital versus film-screen mammography among U.S. women aged 50-79 in the Breast Cancer Surveillance Consortium cohort. 42 …”

Breast cancer awareness, attitude and screening practices in Nigeria: A systematic review

“…The American Cancer Society guidelines for early detection of breast cancer recommend yearly mammogram starting at the age of forty, clinical breast examination (CBE) about every three years for women in their twenties and thirties, and every year for women at age forty and over and also recommends Breast SelfExamination (BSE) for women starting their twenties (Kerlikowske et al, 2011;Smith et al, 2003). Screening mammography though, is the most effective screening method in the early detection of breast cancer (Islam and Aziz, 2012).…”