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Farber R, Marinovich ML, Pinna A, Houssami N, McGeechan K, Barratt A, Bell KJL. Systematic review and meta-analysis of prognostic characteristics for breast cancers in populations with digital vs film mammography indicate the transition may have increased both early detection and overdiagnosis. J Clin Epidemiol 2024; 171:111339. [PMID: 38570078 DOI: 10.1016/j.jclinepi.2024.111339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Film mammography has been replaced by digital mammography in breast screening programs globally. This led to a small increase in the rate of detection, but whether the detection of clinically important cancers increased is uncertain. We aimed to assess the impact on tumor characteristics of screen-detected and interval breast cancers. STUDY DESIGN AND SETTING We searched seven databases from inception to October 08, 2023, for publications comparing film and digital mammography within the same population of asymptomatic women at population (average) risk of breast cancer. We recorded reported tumor characteristics and assessed risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions tool. We synthesized results using meta-analyses of random effects. RESULTS Eighteen studies were included in the analysis from 8 countries, including 11,592,225 screening examinations (8,117,781 film; 3,474,444 digital). There were no differences in tumor size, morphology, grade, node status, receptor status, or stage in the pooled differences for screen-detected and interval invasive cancer tumor characteristics. There were statistically significant increases in screen-detected ductal carcinoma in situ (DCIS) across all grades: 0.05 (0.00-0.11), 0.14 (0.05-0.22), and 0.19 (0.05-0.33) per 1000 screens for low, intermediate, and high-grade DCIS, respectively. There were similar (non-statistically significant) increases in screen-detected invasive cancer across all grades. CONCLUSION The increased detection of all grades of DCIS and invasive cancer may indicate both increased early detection of more aggressive disease and increased overdiagnosis.
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Affiliation(s)
- Rachel Farber
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Michael L Marinovich
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Audrey Pinna
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; Department of medical imaging, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nehmat Houssami
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Alexandra Barratt
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Katy J L Bell
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia.
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Farber R, Houssami N, McGeechan K, Barratt A, Bell KJL. Breast Cancer Stage and Size Detected with Film versus Digital Mammography in New South Wales, Australia: A Population-Based Study Using Routinely Collected Data. Cancer Epidemiol Biomarkers Prev 2024; 33:671-680. [PMID: 38407377 DOI: 10.1158/1055-9965.epi-23-0813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/25/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Digital mammography has replaced film mammography in breast-screening programs globally, including Australia. This led to an increase in the rate of detection, but whether there was increased detection of clinically important cancers is uncertain. METHODS In this population-wide retrospective cohort study in New South Wales, Australia spanning 2004 to 2016 and including 4,631,656 screens, there were 22,965 cancers in women screened with film (n = 11,040) or digital mammography (n = 11,925). We examined the change in tumor characteristics overall and how these rates changed over time, accounting for changes in background rates using an interrupted time-series. Comparisons were made with unscreened women (n = 26,326) during this time. RESULTS We found increased detection of in situ cancer (3.36 per 10,000 screens), localized invasive, and smaller-sized breast cancers attributable to the change in mammography technology, whereas screen-detected intermediate-sized and metastatic breast cancers decreased. Rates of early-stage and intermediate-sized interval cancers increased, and late-stage (-1.62 per 10,000 screens) and large interval cancers decreased. In unscreened women, there were small increases in the temporal trends of cancers across all stages. CONCLUSIONS At least some of the increased detection of smaller early-stage cancers may have translated into a reduction in larger and late-stage cancers, indicating beneficial detection of cancers that would have otherwise progressed. However, the increased detection of smaller early-stage and small cancers may also have increased over-diagnosis of lesions that would otherwise have not caused harm. IMPACT Robust evaluation of potential benefits and harms is needed after changes to screening programs. See related In the Spotlight, p. 638.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katy J L Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Román M, Louro J, Posso M, Vidal C, Bargalló X, Vázquez I, Quintana MJ, Alcántara R, Saladié F, del Riego J, Peñalva L, Sala M, Castells X. Long-Term Risk of Breast Cancer after Diagnosis of Benign Breast Disease by Screening Mammography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052625. [PMID: 35270331 PMCID: PMC8909630 DOI: 10.3390/ijerph19052625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022]
Abstract
Assessing the long-term risk of breast cancer after diagnosis of benign breast disease by mammography is of utmost importance to design personalised screening strategies. We analysed individual-level data from 778,306 women aged 50–69 years with at least one mammographic screening participation in any of ten breast cancer screening centers in Spain from 1996 to 2015, and followed-up until 2017. We used Poisson regression to compare the rates of incident breast cancer among women with and without benign breast disease. During a median follow-up of 7.6 years, 11,708 (1.5%) women had an incident of breast cancer and 17,827 (2.3%) had a benign breast disease. The risk of breast cancer was 1.77 times higher among women with benign breast disease than among those without (95% CI: 1.61 to 1.95). The relative risk increased to 1.99 among women followed for less than four years, and remained elevated for two decades, with relative risk 1.96 (95% CI: 1.32 to 2.92) for those followed from 12 to 20 years. Benign breast disease is a long-term risk factor for breast cancer. Women with benign breast disease could benefit from closer surveillance and personalized screening strategies.
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Affiliation(s)
- Marta Román
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
| | - Javier Louro
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Margarita Posso
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Carmen Vidal
- Cancer Prevention and Monitoring Program, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain;
| | - Xavier Bargalló
- Department of Radiology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Ivonne Vázquez
- Pathology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Rodrigo Alcántara
- Radiology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - Francina Saladié
- Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain;
| | - Javier del Riego
- Department of Radiology, Parc Taulí University Hospital-UAB, 08208 Sabadell, Spain;
| | - Lupe Peñalva
- Breast Cancer Screening Technical Office, Private Foundation Asil Hospital, 08402 Granollers, Spain;
| | - Maria Sala
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
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Breast density, benign breast disease, and risk of breast cancer over time. Eur Radiol 2021; 31:4839-4847. [PMID: 33409776 DOI: 10.1007/s00330-020-07490-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/06/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Assessing the combined effect of mammographic density and benign breast disease is of utmost importance to design personalized screening strategies. METHODS We analyzed individual-level data from 294,943 women aged 50-69 years with at least one mammographic screening participation in any of four areas of the Spanish Breast Cancer Screening Program from 1995 to 2015, and followed up until 2017. We used partly conditional Cox models to assess the association between benign breast disease, breast density, and the risk of breast cancer. RESULTS During a median follow-up of 8.0 years, 3697 (1.25%) women had a breast cancer diagnosis and 5941 (2.01%) had a benign breast disease. More than half of screened women had scattered fibroglandular density (55.0%). The risk of breast cancer independently increased with the presence of benign breast disease and with the increase in breast density (p for interaction = 0.84). Women with benign breast disease and extremely dense breasts had a threefold elevated risk of breast cancer compared with those with scattered fibroglandular density and without benign breast disease (hazard ratio [HR] = 3.07; 95%CI = 2.01-4.68). Heterogeneous density and benign breast disease was associated with nearly a 2.5 elevated risk (HR = 2.48; 95%CI = 1.66-3.70). Those with extremely dense breast without a benign breast disease had a 2.27 increased risk (95%CI = 2.07-2.49). CONCLUSIONS Women with benign breast disease had an elevated risk for over 15 years independently of their breast density category. Women with benign breast disease and dense breasts are at high risk for future breast cancer. KEY POINTS • Benign breast disease and breast density were independently associated with breast cancer. • Women with benign breast disease had an elevated risk for up to 15 years independently of their mammographic density category.
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Roubidoux MA, Shih-Pei Wu P, Nolte ELR, Begay JA, Joe AI. Availability of prior mammograms affects incomplete report rates in mobile screening mammography. Breast Cancer Res Treat 2018; 171:667-673. [PMID: 29951970 DOI: 10.1007/s10549-018-4861-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/20/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Mobile mammography can improve access to screening mammography in rural areas and underserved populations. We evaluated the frequency of incomplete reports in mobile mammography screening and the relationships between prior mammograms and recall rates. METHODS The frequency of incomplete mammogram reports, the subgroups of those needing prior comparison mammograms, recalls for additional imaging, and availability of prior mammograms of a mobile screening mammography unit were compared with fixed site mammography from January 1, 2007 through December 31, 2009. All mobile unit mammograms were full field digital mammography (FFDM). Differences between rates of recall, incomplete reports, and availability of prior mammograms were calculated using the Chi-Square statistic. RESULTS Of 2640 mobile mammography cases, 21.9% (578) reports were incomplete, versus 15.2% (7653) (p ≤ 0.001) of 50325 fixed site reports. Of incomplete cases, recall for additional imaging occurred among 8.3% (218) of mobile mammography reports versus 11.3% (5708) (p ≤ 0.001) of fixed site reports. Prior mammograms were needed among 13.6% (360) of mobile mammography versus 3.9% (1945) (p ≤ 0.001) of fixed site reports. Mobile mammography recall rate varied with availability of prior mammograms: 16.0% (54) when no prior mammograms, 7.6% (127) when prior mammograms were elsewhere but unavailable and 5.9% (37) when prior FFDM were immediately available (p ≤ 0.001). CONCLUSIONS Incomplete reports were more frequent in mobile mammography than the fixed site. The availability of prior comparison mammograms at time of interpretation decreased the rate of incomplete mammogram reports. Recall rates were higher without prior comparison mammograms and lowest when comparison FFDM mammograms were available.
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Affiliation(s)
- Marilyn A Roubidoux
- Division of Breast Imaging, Department of Radiology, Michigan Medicine - University of Michigan, University of Michigan Health System, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, 2902TC, Ann Arbor, MI, 48109, USA.
| | - Peggy Shih-Pei Wu
- Kaiser Permanente, South Sacramento Medical Group, 6600 Bruceville Rd, 1st Floor, Sacramento, CA, 95823, USA
| | - Emily L Roen Nolte
- Rosalind Franklin University of Medicine and Science, 3333 Greenbay Rd, North Chicago, IL, 60064, USA
| | - Joel A Begay
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Annette I Joe
- Division of Breast Imaging, Department of Radiology, Michigan Medicine - University of Michigan, University of Michigan Health System, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, 2902TC, Ann Arbor, MI, 48109, USA
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Fitzpatrick PE, Greehy G, Mooney MT, Flanagan F, Larke A, Connors A, O’Doherty A. Evolution of the National Breast Screening Programme in Ireland: Two-year interval analysis (2004–2013) of BreastCheck. J Med Screen 2017; 25:191-196. [DOI: 10.1177/0969141317738034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Monitoring breast screening programmes is essential to ensure quality. BreastCheck, the national breast screening programme in the Republic of Ireland, commenced screening in 2000, with full national expansion in 2007, and digital mammography introduced in 2008. We aimed to review the performance of BreastCheck from 1 January 2004 to 31 December 2013. Methods Using the customised clinical and administrative database, performance indicator data were collected from BreastCheck and compared with programme and European guideline standards. Results Over the decade, 972,236 screening examinations were performed. Uptake initially rose following national expansion, but fell in the subsequent years to <70% in 2012–2013. Following the introduction of digital mammography, initial recall rates increased from 5.2% in 2004–2005 to 8.1% in 2012–2013. Subsequent recall rates remained within the target of <3%. On average, invasive cancer detection rates were 6.6/1000 for initial and 4.5/1000 for subsequent women. Small cancer detection rates were for <15 mm 43.4% (initial women) and 51.7% (subsequent) and for ≤10 mm 24.0% (initial) and 29.5% (subsequent). Ductal carcinoma in situ detection as a percentage of all cancers averaged 21.2% for initial and 20.0% for subsequent women. The majority were intermediate or high-grade ductal carcinoma in situ. The positive predictive value was 11.9% for initial and 21.8% for subsequent women. Standardized detection ratios remained above the programme target. Conclusion Revised indicators to reflect the digital mammography era are anticipated in revised European Guidelines on breast cancer screening.
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Affiliation(s)
- Patricia E Fitzpatrick
- National Screening Service, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, UCD, Belfield, Dublin, Ireland
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Le MT, Mothersill CE, Seymour CB, McNeill FE. Is the false-positive rate in mammography in North America too high? Br J Radiol 2016; 89:20160045. [PMID: 27187600 PMCID: PMC5124917 DOI: 10.1259/bjr.20160045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/04/2016] [Accepted: 05/16/2016] [Indexed: 01/23/2023] Open
Abstract
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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Affiliation(s)
- Michelle T Le
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Carmel E Mothersill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Colin B Seymour
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Fiona E McNeill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
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Théberge I, Vandal N, Langlois A, Pelletier É, Brisson J. Detection Rate, Recall Rate, and Positive Predictive Value of Digital Compared to Screen-Film Mammography in the Quebec Population-Based Breast Cancer Screening Program. Can Assoc Radiol J 2016; 67:330-338. [PMID: 27451910 DOI: 10.1016/j.carj.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/21/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The study sought to compare performance indicators of computed radiography (CR) using different plate readers, digital direct radiography (DR), and screen-film mammography (SFM) in a population-based screening program. METHODS This analysis involved women 50-69 years of age who participated in the breast screening program of Quebec (Canada) and who had screening mammogram between January 1, 2007, and September 30, 2012. The detection rate, recall rate, and positive predictive value of CR (n = 672,125 mammograms) and DR (n = 60,023) were compared to SFM (n = 782,894) using mixed-effect logistic regression, adjusting for potential confounders. No institutional review board approval was required. RESULTS CR was not associated with change in cancer detection rate (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.88-1.03), but with a small increase in recall rate (OR: 1.03; 95% CI: 1.01-1.06) compared to SFM. The association of CR with recall rate varies with the CR plate reader manufacturer (P < .0001). DR was not associated with change in detection rate (OR: 1.06; 95% CI: 0.89-1.25), but with an increase in the recall rate (OR: 1.25; 95% CI: 1.19-1.30) compared to SFM. CONCLUSIONS In our screening program, digital mammograms gave detection rates equivalent to those of SFM, but with an increase of recall rate, particularly for DR. If this situation persists, the adoption of DR may increase the adverse effects of screening with little or no benefit for women.
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Affiliation(s)
- Isabelle Théberge
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada.
| | - Nathalie Vandal
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - André Langlois
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Éric Pelletier
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Jacques Brisson
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec City, Québec, Canada
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Román M, Castells X, Hofvind S, von Euler‐Chelpin M. Risk of breast cancer after false-positive results in mammographic screening. Cancer Med 2016; 5:1298-306. [PMID: 26916154 PMCID: PMC4924388 DOI: 10.1002/cam4.646] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/25/2015] [Accepted: 12/27/2015] [Indexed: 11/09/2022] Open
Abstract
Women with false-positive results are commonly referred back to routine screening. Questions remain regarding their long-term outcome of breast cancer. We assessed the risk of screen-detected breast cancer in women with false-positive results. We conducted a joint analysis using individual level data from the population-based screening programs in Copenhagen and Funen in Denmark, Norway, and Spain. Overall, 150,383 screened women from Denmark (1991-2008), 612,138 from Norway (1996-2010), and 1,172,572 from Spain (1990-2006) were included. Poisson regression was used to estimate the relative risk (RR) of screen-detected cancer for women with false-positive versus negative results. We analyzed information from 1,935,093 women 50-69 years who underwent 6,094,515 screening exams. During an average 5.8 years of follow-up, 230,609 (11.9%) women received a false-positive result and 27,849 (1.4%) were diagnosed with screen-detected cancer. The adjusted RR of screen-detected cancer after a false-positive result was 2.01 (95% CI: 1.93-2.09). Women who tested false-positive at first screen had a RR of 1.86 (95% CI: 1.77-1.96), whereas those who tested false-positive at third screening had a RR of 2.42 (95% CI: 2.21-2.64). The RR of breast cancer at the screening test after the false-positive result was 3.95 (95% CI: 3.71-4.21), whereas it decreased to 1.25 (95% CI: 1.17-1.34) three or more screens after the false-positive result. Women with false-positive results had a twofold risk of screen-detected breast cancer compared to women with negative tests. The risk remained significantly higher three or more screens after the false-positive result. The increased risk should be considered when discussing stratified screening strategies.
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Affiliation(s)
- Marta Román
- Department of screeningCancer Registry of NorwayOsloNorway
- National Advisory Unit for Women's HealthOslo University HospitalOsloNorway
| | - Xavier Castells
- Department of Epidemiology and EvaluationIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- Network on Health Services in Chronic Diseases (REDISSEC)BarcelonaSpain
| | - Solveig Hofvind
- Department of screeningCancer Registry of NorwayOsloNorway
- Oslo and Akershus University College of Applied SciencesFaculty of Health ScienceOsloNorway
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Gossner J. Digital Mammography in Young Women: Is a Single View Sufficient? J Clin Diagn Res 2016; 10:TC10-2. [PMID: 27134963 DOI: 10.7860/jcdr/2016/17342.7502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Single view mammography may be a less time consuming, more comfortable and radiation reduced alternative for young women, but there are no studies examining this approach after the implementation of digital mammography into clinical practice. MATERIALS AND METHODS Retrospective analysis of all mammographies performed in women younger than 40 years during a 24 month period. The sample consisted of 109 women with 212 examined breasts. All patients initially received standard two- view mammography. In the study setting the MLO- views were read by a single viewer and compared to a composite reference standard. RESULTS In this sample 7 malignant findings were present and the review of the MLO-view detected 6 of them (85%). In patients with dense breasts 4 out of 5 malignant findings were found on the single-view (sensitivity 80%) and all 2 malignant findings were detected in patients with low breast density (sensitivity 100%). There were 7 false positive findings (3.3%). i.e. in total 8 out of 212 examined breasts were therefore misinterpreted (3.8%). CONCLUSION Single view digital mammography detects the vast majority of malignant findings, especially in low density breast tissue and the rate of false-positive findings is within acceptable limits. Therefore this approach may be used in different scenarios (for example in increasing patient throughout in resource poor settings, reducing radiation burden in the young or in combination with ultrasound to use the strengths of both methods). More research on this topic is needed to establish its potential role in breast imaging.
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Affiliation(s)
- Johannes Gossner
- Faculty, Department of Clinical Radiology, Evangelisches Krankenhaus Göttingen- Weende , An der Lutter 24, 37024 Göttingen, Germany
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Chiarelli AM, Prummel MV, Muradali D, Shumak RS, Majpruz V, Brown P, Jiang H, Done SJ, Yaffe MJ. Digital versus screen-film mammography: impact of mammographic density and hormone therapy on breast cancer detection. Breast Cancer Res Treat 2015; 154:377-87. [PMID: 26518019 DOI: 10.1007/s10549-015-3622-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/24/2015] [Indexed: 11/25/2022]
Abstract
Most studies that have examined the effects of mammographic density and hormone therapy use on breast cancer detection have included screen-film mammography. This study further examines this association in post-menopausal women screened by digital mammography. Approved by the University of Toronto Research Ethics Board, this study identified 688,418 women of age 50-74 years screened with digital or screen-film mammography from 2008 to 2009 within the Ontario Breast Screening Program. Of 2993 eligible women with invasive breast cancer, 2450 were contacted and 1421 participated (847 screen-film mammography, 574 digital direct radiography). Mammographic density was measured by study radiologists using the standard BI-RADS classification system and by a computer-assisted method. Information on hormone therapy use was collected by a telephone-administered questionnaire. Logistic regression and two-tailed tests for significance evaluated associations between factors and detection method by mammography type. Women with >75 % radiologist-measured mammographic density compared to those with <25 % were more likely to be diagnosed with an interval than screen-detected cancer, with the difference being greater for those screened with screen-film (OR = 6.40, 95 % CI 2.30-17.85) than digital mammography (OR = 2.41, 95 % CI 0.67-8.58) and aged 50-64 years screened with screen-film mammography (OR = 10.86, 95 % CI 2.96-39.57). Recent former hormone therapy users were also at an increased risk of having an interval cancer with the association being significant for women screened with digital mammography (OR = 2.08, 95 % CI 1.17-3.71). Breast screening using digital mammography lowers the risk of having an interval cancer for post-menopausal women aged 50-64 with greater mammographic density.
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Affiliation(s)
- Anna M Chiarelli
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Maegan V Prummel
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - Derek Muradali
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - Rene S Shumak
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - Vicky Majpruz
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - Patrick Brown
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hedy Jiang
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada
| | - Susan J Done
- The Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, Canada
| | - Martin J Yaffe
- Women's College Hospital, Sunnybrook Health Sciences Centre, Toronto, Canada
- Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Canada
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Prummel MV, Muradali D, Shumak R, Majpruz V, Brown P, Jiang H, Done SJ, Yaffe MJ, Chiarelli AM. Digital Compared with Screen-Film Mammography: Measures of Diagnostic Accuracy among Women Screened in the Ontario Breast Screening Program. Radiology 2015; 278:365-73. [PMID: 26334680 DOI: 10.1148/radiol.2015150733] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare measures of diagnostic accuracy between large concurrent cohorts of women screened with digital computed radiography (CR), direct radiography (DR), and screen-film mammography (SFM). MATERIALS AND METHODS This study was approved by the University of Toronto Research Ethics Board; informed consent was not required. Three concurrent cohorts of women aged 50-74 years who were screened from 2008-2009 in the Ontario Breast Screening Program with SFM (487,334 screening examinations, 403,688 women), DR (254,758 screening examinations, 220,520 women), or CR (74,140 screening examinations, 64,210 women) were followed for 2 years or until breast cancer diagnosis. Breast cancers were classified as screening-detected or interval on the basis of the woman's final screening and assessment results. Interval cancer rate (per 10 000 negative screening examinations), sensitivity, and specificity were compared across the cohorts by using mixed-effects logistic regression analysis. RESULTS Interval cancer rates were higher, although not significantly so, for CR (15.2 per 10,000; 95% confidence interval [CI]: 12.8, 17.8) and were similar for DR (13.7 per 10,000; 95% CI: 12.4, 15.0) compared with SFM (13.0 per 10,000; 95% CI: 12.1, 13.9). For CR versus SFM, specificity was similar while sensitivity was significantly lower (odds ratio [OR] = 0.62; 95% CI: 0.47, 0.83; P = .001), particularly for invasive cancers detected at a rescreening examination, for women with breast density of less than 75%, for women with no family history, and for postmenopausal women. For DR versus SFM, sensitivity was similar while specificity was lower (OR = 0.92; 95% CI: 0.87, 0.98; P = .01), particularly for rescreening examinations, for women aged 60-74 years, for women with breast density of less than 75%, for women with a family history, and for women who were postmenopausal. CONCLUSION Given the 38% lower sensitivity of CR imaging systems compared with SFM, programs should assess the continued use of this technology for breast screening.
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Affiliation(s)
- Maegan V Prummel
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Derek Muradali
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Rene Shumak
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Vicky Majpruz
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Patrick Brown
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Hedy Jiang
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Susan J Done
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Martin J Yaffe
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Anna M Chiarelli
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
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Sala M, Domingo L, Macià F, Comas M, Burón A, Castells X. Does digital mammography suppose an advance in early diagnosis? Trends in performance indicators 6 years after digitalization. Eur Radiol 2014; 25:850-9. [PMID: 25257856 PMCID: PMC4328118 DOI: 10.1007/s00330-014-3431-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/19/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
Purpose To provide a complete evaluation of the long-term impact of full-field digital mammography (FFDM) on the improvement of early diagnosis in a population-based screening program. Methods We included 82,961 screen-film mammograms (SFM) and 79,031 FFDM from women aged 50–69 screened biennially from 1995–2010 in Spain and followed-up to 2012. The first screening round of the program was excluded. Rates of cancer detection, interval cancer, tumoral characteristics and other quality indicators were compared between SFM and FFDM periods using the Chi-square test. Multivariate logistic regression models were fitted. Results Detection of ductal carcinoma in situ (DCIS) significantly increased with FFDM (0.05 % vs 0.09 %; p = 0.010), along with the proportion of small invasive cancers (<20 mm) (69.37 % vs 78.90 %; p = 0.040). The false-positive rate decreased with FFDM (4.79 % vs 3.38 %; p < 0.001) without differences in the cancer detection rate (0.42 % vs 0.43 %; p = 0.685) or in the interval cancer rate (0.14 % vs 0.14 %; p = 0.816). Adjusted models showed a significant increase in the detection of DCIS in the FFDM periods. Conclusion Digitalization has supposed an improvement in early diagnosis because DCIS and small invasive cancers increased without a change in detection rate. Moreover, false-positive reduction without an increase in the interval cancer rate was confirmed. Key Points • Cancer detection did not increase after 6 years of digital mammography • Ductal carcinoma in situ rates remained higher throughout the digital period • The proportion of small invasive cancers was higher with digital mammography • We observed an improvement in early diagnosis with digital mammography • False-positive rates remained lower throughout the digital period without interval cancer increase
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Affiliation(s)
- Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg. Marítim 25-29, 08003, Barcelona, Spain,
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14
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Prummel MV, Done SJ, Muradali D, Majpruz V, Brown P, Jiang H, Shumak RS, Yaffe MJ, Holloway CMB, Chiarelli AM. Digital compared to screen-film mammography: breast cancer prognostic features in an organized screening program. Breast Cancer Res Treat 2014; 147:389-99. [PMID: 25108740 DOI: 10.1007/s10549-014-3088-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/27/2014] [Indexed: 11/29/2022]
Abstract
Our previous study found cancer detection rates were equivalent for direct radiography compared to screen-film mammography, while rates for computed radiography were significantly lower. This study compares prognostic features of invasive breast cancers by type of mammography. Approved by the University of Toronto Research Ethics Board, this study identified invasive breast cancers diagnosed among concurrent cohorts of women aged 50-74 screened by direct radiography, computed radiography, or screen-film mammography from January 1, 2008 to December 31, 2009. During the study period, 816,232 mammograms were performed on 668,418 women, and 3,323 invasive breast cancers were diagnosed. Of 2,642 eligible women contacted, 2,041 participated (77.3 %). The final sample size for analysis included 1,405 screen-detected and 418 interval cancers (diagnosed within 24 months of a negative screening mammogram). Polytomous logistic regression was performed to evaluate the association between tumour characteristics and type of mammography, and between tumour characteristics and detection method. Odds ratios (OR) and 95 % confidence intervals (CI) were recorded. Cancers detected by computed radiography compared to screen-film mammography were significantly more likely to be lymph node positive (OR 1.94, 95 %CI 1.01-3.73) and have higher stage (II:I, OR 2.14, 95 %CI 1.11-4.13 and III/IV:I, OR 2.97, 95 %CI 1.02-8.59). Compared to screen-film mammography, significantly more cancers detected by direct radiography (OR 1.64, 95 %CI 1.12-2.38) were lymph node positive. Interval cancers had worse prognostic features compared to screen-detected cancers, irrespective of mammography type. Screening with computed radiography may lead to the detection of cancers with a less favourable stage distribution compared to screen-film mammography that may reflect a delayed diagnosis. Screening programs should re-evaluate their use of computed radiography for breast screening.
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Affiliation(s)
- Maegan V Prummel
- Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada,
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Roman M, Skaane P, Hofvind S. The cumulative risk of false-positive screening results across screening centres in the Norwegian Breast Cancer Screening Program. Eur J Radiol 2014; 83:1639-44. [PMID: 24972452 DOI: 10.1016/j.ejrad.2014.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/20/2014] [Accepted: 05/26/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recall for assessment in mammographic screening entails an inevitable number of false-positive screening results. This study aimed to investigate the variation in the cumulative risk of a false positive screening result and the positive predictive value across the screening centres in the Norwegian Breast Cancer Screening Program. METHODS We studied 618,636 women aged 50-69 years who underwent 2,090,575 screening exams (1996-2010. Recall rate, positive predictive value, rate of screen-detected cancer, and the cumulative risk of a false positive screening result, without and with invasive procedures across the screening centres were calculated. Generalized linear models were used to estimate the probability of a false positive screening result and to compute the cumulative false-positive risk for up to ten biennial screening examinations. RESULTS The cumulative risk of a false-positive screening exam varied from 10.7% (95% CI: 9.4-12.0%) to 41.5% (95% CI: 34.1-48.9%) across screening centres, with a highest to lowest ratio of 3.9 (95% CI: 3.7-4.0). The highest to lowest ratio for the cumulative risk of undergoing an invasive procedure with a benign outcome was 4.3 (95% CI: 4.0-4.6). The positive predictive value of recall varied between 12.0% (95% CI: 11.0-12.9%) and 19.9% (95% CI: 18.3-21.5%), with a highest to lowest ratio of 1.7 (95% CI: 1.5-1.9). CONCLUSIONS A substantial variation in the performance measures across the screening centres in the Norwegian Breast Cancer Screening Program was identified, despite of similar administration, procedures, and quality assurance requirements. Differences in the readers' performance is probably of influence for the variability. This results underscore the importance of continuous surveillance of the screening centres and the radiologists in order to sustain and improve the performance and effectiveness of screening programs.
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Affiliation(s)
- M Roman
- Cancer Registry of Norway, Oslo, Norway; Department of Women and Children's Health, Oslo University Hospital, Oslo, Norway.
| | - P Skaane
- Department of Radiology, Oslo University Hospital Ullevaal, University of Oslo, Oslo, Norway.
| | - S Hofvind
- Cancer Registry of Norway, Oslo, Norway; Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway.
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Comas M, Arrospide A, Mar J, Sala M, Vilaprinyó E, Hernández C, Cots F, Martínez J, Castells X. Budget impact analysis of switching to digital mammography in a population-based breast cancer screening program: a discrete event simulation model. PLoS One 2014; 9:e97459. [PMID: 24832200 PMCID: PMC4022526 DOI: 10.1371/journal.pone.0097459] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/20/2014] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program. Methods A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared. Results Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term. Conclusions Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs.
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Affiliation(s)
- Mercè Comas
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- * E-mail:
| | - Arantzazu Arrospide
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Gipuzkoa Oeste Research Unit, Hospital Alto Deba, Arrasate, Spain
| | - Javier Mar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Gipuzkoa Oeste Research Unit, Hospital Alto Deba, Arrasate, Spain
| | - Maria Sala
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Ester Vilaprinyó
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Basic Medical Sciences Department, Biomedical Research Institute of Lleida (IRBLLEIDA)-University of Lleida, Lleida, Spain
| | - Cristina Hernández
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Francesc Cots
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Management Control Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Juan Martínez
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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Weigel S, Berkemeyer S, Girnus R, Sommer A, Lenzen H, Heindel W. Digital Mammography Screening with Photon-counting Technique: Can a High Diagnostic Performance Be Realized at Low Mean Glandular Dose? Radiology 2014; 271:345-55. [DOI: 10.1148/radiol.13131181] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Comparison of Direct Digital Mammography, Computed Radiography, and Film-Screen in the French National Breast Cancer Screening Program. AJR Am J Roentgenol 2014; 202:229-36. [DOI: 10.2214/ajr.12.10419] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Domingo L, Romero A, Blanch J, Salas D, Sánchez M, Rodríguez-Arana A, Ferrer J, Ibáñez J, Vega A, Laso MS, Castells X, Sala M. Clinical and radiological features of breast tumors according to history of false-positive results in mammography screening. Cancer Epidemiol 2013; 37:660-5. [DOI: 10.1016/j.canep.2013.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 12/01/2022]
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Mellado Rodríguez M, Osa Labrador A. Cribado de cáncer de mama. Estado actual. RADIOLOGIA 2013; 55:305-14. [DOI: 10.1016/j.rx.2012.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 11/29/2022]
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Mellado Rodríguez M, Osa Labrador A. Breast cancer screening: Current status. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pollán M, Llobet R, Miranda-García J, Antón J, Casals M, Martínez I, Palop C, Ruiz-Perales F, Sánchez-Contador C, Vidal C, Pérez-Gómez B, Salas-Trejo D. Validation of DM-Scan, a computer-assisted tool to assess mammographic density in full-field digital mammograms. SPRINGERPLUS 2013; 2:242. [PMID: 23865000 PMCID: PMC3693435 DOI: 10.1186/2193-1801-2-242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/03/2013] [Indexed: 11/17/2022]
Abstract
We developed a semi-automated tool to assess mammographic density (MD), a phenotype risk marker for breast cancer (BC), in full-field digital images and evaluated its performance testing its reproducibility, comparing our MD estimates with those obtained by visual inspection and using Cumulus, verifying their association with factors that influence MD, and studying the association between MD measures and subsequent BC risk. Three radiologists assessed MD using DM-Scan, the new tool, on 655 processed images (craniocaudal view) obtained in two screening centers. Reproducibility was explored computing pair-wise concordance correlation coefficients (CCC). The agreement between DM-Scan estimates and visual assessment (semi-quantitative scale, 6 categories) was quantified computing weighted kappa statistics (quadratic weights). DM-Scan and Cumulus readings were compared using CCC. Variation of DM-Scan measures by age, body mass index (BMI) and other MD modifiers was tested in regression mixed models with mammographic device as a random-effect term. The association between DM-Scan measures and subsequent BC was estimated in a case–control study. All BC cases in screening attendants (2007–2010) at a center with full-field digital mammography were matched by age and screening year with healthy controls (127 pairs). DM-Scan was used to blindly assess MD in available mammograms (112 cases/119 controls). Unconditional logistic models were fitted, including age, menopausal status and BMI as confounders. DM-Scan estimates were very reliable (pairwise CCC: 0.921, 0.928 and 0.916). They showed a reasonable agreement with visual MD assessment (weighted kappa ranging 0.79-0.81). DM-Scan and Cumulus measures were highly concordant (CCC ranging 0.80-0.84), but ours tended to be higher (4%-5% on average). As expected, DM-Scan estimates varied with age, BMI, parity and family history of BC. Finally, DM-Scan measures were significantly associated with BC (p-trend=0.005). Taking MD<7% as reference, OR per categories of MD were: OR7%-17%=1.32 (95% CI=0.59-2.99), OR17%-28%=2.28 (95% CI=1.03-5.04) and OR>=29%=3.10 (95% CI=1.35-7.14). Our results confirm that DM-Scan is a reliable tool to assess MD in full-field digital mammograms.
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Affiliation(s)
- Marina Pollán
- National Center for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, Madrid, 28029 Spain ; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Carlos III Institute of Health, Monforte de Lemos 5, Madrid, 28029 Spain ; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Monforte de Lemos 5, Madrid, 28029 Spain
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Abstract
BACKGROUND Digital mammography is the dominant modality for breast cancer screening in the United States. No previous studies have investigated as to how introducing digital mammography affects downstream breast-related care. OBJECTIVE Compare breast-related health care use after a screening mammogram before and after introduction of digital mammography. RESEARCH DESIGN AND SUBJECTS Longitudinal study of screening mammograms from 14 radiology facilities contributing data to the Breast Cancer Surveillance Consortium performed 1 year before and 4 years after each facility introduced digital mammography, along with linked Medicare claims. We included 30,211 mammograms for women aged 66 years and older without breast cancer. MEASURES Rates of false-positive recall and short-interval follow-up were based on radiologists' assessments and recommendations; rates of follow-up mammography, ultrasound, and breast biopsy use were based on Medicare claims. RESULTS False-positive recall rates increased after the introduction of digital mammography. Follow-up mammography use was significantly higher across all 4 years after a facility began using digital mammography compared with the year before [year 1 odds ratio (OR) = 1.7, 95% confidence interval (CI), 1.4-2.1]. Among women with false-positive mammography results, use of ultrasound decreased significantly in the second through fourth years after digital mammography began (year 2 OR = 0.4, 95% CI, 0.3-0.6). CONCLUSIONS Introduction of a new technology led to changes in health care use that persisted for at least 4 years. Comparative effectiveness research on new technologies should consider not only diagnostic performance but also downstream utilization attributable to this apparent learning curve.
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Nederend J, Duijm LEM, Louwman MWJ, Groenewoud JH, Donkers-van Rossum AB, Voogd AC. Impact of transition from analog screening mammography to digital screening mammography on screening outcome in The Netherlands: a population-based study. Ann Oncol 2012; 23:3098-3103. [PMID: 22745215 DOI: 10.1093/annonc/mds146] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Full-field digital mammography (FFDM) has replaced screen-film mammography (SFM) in most breast screening programs. We analyzed the impact of this replacement on the screening outcome. PATIENTS AND METHODS The study population consisted of a consecutive series of 60 770 analog and 63 182 digital screens. During a 1-year follow-up, we collected breast imaging reports, biopsy results and surgical reports of all the referred women. RESULTS The referral rate and the cancer detection rate at FFDM were, respectively, 3.0% and 6,6‰, compared with 1.5% (P < 0.001) and 4.9‰ (P < 0.001) at SFM. Positive predictive values of referral and percutaneous biopsies were lower at FFDM, respectively, 21.9% versus 31.6% (P < 0.001) and 42.9% versus 62.8% (P < 0.001). Per 1000 screened women, there was a significant increase with FFDM versus SFM in the detection rate of low- and intermediate-grade ductal carcinoma in situ (DCIS) (+0.7), invasive T1a-c cancers (+0.9), invasive ductal cancers (+0.9), low-grade (+1.1), node-negative invasive cancers (+1.2), estrogen-receptor or progesterone-receptor-positive invasive cancers (respectively, +0.9 and +1.1) and Her2/Neu-negative (+0.8) invasive cancers. Mastectomy rates were stable at 1.1 per 1,000 screens. CONCLUSIONS FFDM significantly increased the referral rate and cancer detection rate, at the expense of a lower positive predictive value of referral and biopsy. Extra tumors detected at FFDM were mostly low-intermediate grade DCIS and smaller invasive tumors, of more favorable tumor characteristics. Mastectomy rates were not increased in the FFDM population, while increased over-diagnosis cannot be excluded.
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Affiliation(s)
- J Nederend
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
| | - L E M Duijm
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - M W J Louwman
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Eindhoven, The Netherlands
| | - J H Groenewoud
- Expertise Center Transitions of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | | | - A C Voogd
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
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Situación de la investigación en el cribado de cáncer de mama en España: implicaciones para la prevención. GACETA SANITARIA 2012; 26:574-81. [DOI: 10.1016/j.gaceta.2011.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/15/2011] [Accepted: 11/16/2011] [Indexed: 11/19/2022]
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Molina-Barceló A, Salas Trejo D, Miranda García J. Satisfacción de las mujeres con la duración del proceso de valoración adicional en el cribado mamográfico. GACETA SANITARIA 2011; 25:357-62. [DOI: 10.1016/j.gaceta.2011.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 03/01/2011] [Accepted: 03/15/2011] [Indexed: 11/27/2022]
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Domingo L, Romero A, Belvis F, Sánchez M, Ferrer J, Salas D, Ibáñez J, Vega A, Ferrer F, Laso MS, Macià F, Castells X, Sala M. Differences in radiological patterns, tumour characteristics and diagnostic precision between digital mammography and screen-film mammography in four breast cancer screening programmes in Spain. Eur Radiol 2011; 21:2020-8. [DOI: 10.1007/s00330-011-2143-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 03/16/2011] [Accepted: 03/27/2011] [Indexed: 11/28/2022]
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