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

Hofvind, Solveig; Skaane, Per; Elmore, Joann G.; Sebuødegård, Sofie; Hoff, Solveig Roth; Lee, Christoph I.

doi:10.1148/radiol.14131502

Cited by 52 publications

(59 citation statements)

References 33 publications

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“…It is unlikely, however, that our findings are the result of a “learning effect,” as screening outcome parameters showed no significant fluctuations during the first 1.5 years of digital screening . The awareness of beneficial effects of higher referral rates on cancer detection and the introduction of digital screening mammography are likely explanations for the increased referral rates and CDRs in our study population, which are now comparable to the Norwegian figures reported by Hofvind et al …”

Section: Discussionsupporting

confidence: 76%

Screening outcome and surgical treatment during and after the transition from screen‐film to digital screening mammography in the south of The Netherlands

Weber

Voogd

Strobbe

et al. 2014

Intl Journal of Cancer

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We determined screening outcome of subsequent screens during and after the transition from screen-film mammography (SFM) to full-field digital mammography (FFDM). A consecutive series of 102,863 subsequent (SFM screens with a prior SFM screen (SFM-SFM cohort), 91,941 FFDM screens with a prior SFM screen (FFDM-SFM cohort) and 90,407 FFDM screens with a prior FFDM screen (FFDM-FFDM cohort) were obtained between January 2006 and July 2013. The referral rate and cancer detection rate (CDR) per 1,000 screens were higher at FFDM-SFM than at SFM-SFM (2.7% vs. 1.2% (p < 0.001) and 7.0 vs. 4.9, p < 0.001), at the expense of a lower positive predictive value (PPV) of referral (25.8% vs. 39.6%, p < 0.001). These parameters were comparable for FFDM-SFM and FFDM-FFDM. Ductal carcinoma in situ (DCIS) and invasive cancer rates increased during transition and remained stable after transition. The rate of DCIS of intermediate grade increased during the transition from 0.2 per 1,000 screened women at SFM-SFM to 0.6 at FFDM-SFM (p < 0.001) and 0.5 at FFDM-FFDM (p 5 0.001). Compared to SFM-SFM, a significantly higher rate of invasive cancers were stage T1a-b at FFDM-SFM (p < 0.001) and FFDM-FFDM (p < 0.001). Breast conserving surgery rates increased during transition (p < 0.001) and remained stable afterwards. The CDR and referral rate remained significantly higher at FFDM than at SFM, at the expense of a decreased PPV of referral. During transition, DCIS was more often of intermediate grade and invasive cancers were of smaller size.Full-field digital mammography (FFDM) has replaced screenfilm mammography (SFM) in most breast cancer screening programs. FFDM improves workflow and there is emerging evidence that digital mammography is superior to SFM with respect to cancer detection, especially in women under the age of 50 years and in women with radiographically dense breasts. 1,2Previous studies have shown conflicting results when comparing SFM and FFDM outcome at screening mammography. Certain studies report no differences in cancer detection rates (CDRs), 3-5 whereas others find an increased 6-8 or decreased CDR 9 at FFDM. Higher CDRs at digital screening usually come with higher referral rates.10 Reports on the impact of FFDM on the positive predictive value (PPV) of referral also vary, but higher referral rates at digital mammography usually increased the number of women falsely referred. 7,11,12 Studies on the effect of the transition to FFDM on the pathology of breast cancer found at breast cancer screening have also shown conflicting results. Early studies have shown that the increased detection of breast cancer at FFDM was predominantly due to the detection of higher detection rates of ductal carcinoma in situ (DCIS). This observation intensified the discussion about over-diagnosis at screening mammography, that is, the detection of slow-growing tumours that would rarely have caused symptoms let alone death. 12-14On the other hand, several recent studies suggest that digital mammography appears to add to the detection of hi...

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Section: Discussionsupporting

confidence: 76%

Screening outcome and surgical treatment during and after the transition from screen‐film to digital screening mammography in the south of The Netherlands

Weber

Voogd

Strobbe

et al. 2014

Intl Journal of Cancer

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“…A large number of studies have reported the superior detection of DCIS with digital than SFM. 60,[64][65][66][67][68] Among 200,000 females screened over a 6-year period, DCIS was accurately found in 0.09% of the females screened by digital means compared with 0.05% by SFM (p 5 0.010). 23 The most common radiographic appearance of DCIS is microcalcification.…”

Section: Screening Protocolmentioning

confidence: 96%

Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

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The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.

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“…The reasons why the incidence of DCIS and LCIS continued to increase after mammography rates plateaued around the year 2000 are not known. However, possible explanations include the widespread transition from screen‐film to digital mammography, which may have increased the rate of detection of these lesions . Analyses of data collected in the Breast Cancer Screening Consortium (BCSC) did not find an increasing trend in the frequency of biopsies after screening mammograms from 1996 to 2008 but did find mild increases in the frequency of invasive cancer and DCIS detected in these biopsies among in women ages 40 to 69 years …”

Section: Selected Findingsmentioning

confidence: 99%

Cancer statistics: Breast cancer in situ

Ward

DeSantis

Lin

et al. 2015

CA A Cancer J Clinicians

202

142

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An estimated 60,290 new cases of breast carcinoma in situ are expected to be diagnosed in 2015, and approximately 1 in 33 women is likely to receive an in situ breast cancer diagnosis in her lifetime. Although in situ breast cancers are relatively common, their clinical significance and optimal treatment are topics of uncertainty and concern for both patients and clinicians. In this article, the American Cancer Society provides information about occurrence and treatment patterns for the 2 major subtypes of in situ breast cancer in the United States-ductal carcinoma in situ and lobular carcinoma in situ-using data from the North American Association of Central Cancer Registries and the 13 oldest Surveillance, Epidemiology, and End Results registries. The authors also present an overview of in situ breast cancer detection, treatment, risk factors, and prevention and discuss research needs and initiatives.

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

Cited by 52 publications

References 33 publications

Screening outcome and surgical treatment during and after the transition from screen‐film to digital screening mammography in the south of The Netherlands

Screening outcome and surgical treatment during and after the transition from screen‐film to digital screening mammography in the south of The Netherlands

Is the false-positive rate in mammography in North America too high?

Cancer statistics: Breast cancer in situ

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