Breast Cancer Screening Results 5 Years after Introduction of Digital Mammography in a Population-based Screening Program

Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grootteplein 10, 6500 HB Nijmegen, the Netherlands.
Radiology (Impact Factor: 6.21). 07/2009; 253(2):353-8. DOI: 10.1148/radiol.2532090225
Source: PubMed

ABSTRACT To compare full-field digital mammography (FFDM) using computer-aided diagnosis (CAD) with screen-film mammography (SFM) in a population-based breast cancer screening program for initial and subsequent screening examinations.
The study was approved by the regional medical ethics review board. Informed consent was not required. In a breast cancer screening facility, two of seven conventional mammography units were replaced with FFDM units. Digital mammograms were interpreted by using soft-copy reading with CAD. The same team of radiologists was involved in the double reading of FFDM and SFM images, with differences of opinion resolved in consensus. After 5 years, screening outcomes obtained with both modalities were compared for initial and subsequent screening examination findings.
A total of 367,600 screening examinations were performed, of which 56,518 were digital. Breast cancer was detected in 1927 women (317 with FFDM). At initial screenings, the cancer detection rate was .77% with FFDM and .62% with SFM. At subsequent screenings, detection rates were .55% and .49%, respectively. Differences were not statistically significant. Recalls based on microcalcifications alone doubled with FFDM. A significant increase in the detection of ductal carcinoma in situ was found with FFDM (P < .01). The fraction of invasive cancers with microcalcifications as the only sign of malignancy increased significantly, from 8.1% to 15.8% (P < .001). Recall rates were significantly higher with FFDM in the initial round (4.4% vs 2.3%, P < .001) and in the subsequent round (1.7% vs 1.2%, P < .001).
With the FFDM-CAD combination, detection performance is at least as good as that with SFM. The detection of ductal carcinoma in situ and microcalcification clusters improved with FFDM using CAD, while the recall rate increased.

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Available from: Adriana MJ Bluekens, May 07, 2015
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    • "In Copenhagen, Denmark the detection rate increased when high resolution ultrasound and stereotactic breast biopsies were introduced in the early 2000s for the diagnostic assessment of women with Breast Imaging Reporting and Data System (BI-RADS) 0 screening mammograms [14]. In some [15] but not all [16] settings, DCIS detection has furthermore been found to increase with the introduction of digital mammography. The variation may also be due to variability in diagnostic criteria among pathologists both within and between countries. "
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    ABSTRACT: Background There is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection. Patients and Methods Data were collected during 2004–2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS. Results Data were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76–3.00); 2.97 (95% CI 2.51–3.51) for detection of breast cancer; and 3.49 (95% CI 2.70–4.51) for detection of DCIS. Conclusions Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.
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    • "For example, commercially available CAD schemes have been routinely used in the clinical practice to assist radiologists reading and interpreting film and digital based screening mammograms in USA and some other countries around the world. Several large scale prospective clinical studies showed that using CAD helped radiologists detect more breast cancers associated with microcalcification clusters [8] [9], while the others showed that using CAD had little impact on radiologists' overall performance in both cancer detection and recall rates [10] or even reduced radiologists' performance level measured by the area under the receiver operating characteristic (ROC) curves [11]. Although there is no universal agreement on whether using CAD schemes at current performance level can actually improve radiologists' performance in interpreting medical images [12], our previous study demonstrated that only using " highly performing " CAD improved radiologists' performance in detecting suspicious breast masses and micro-calcification clusters depicted on mammograms, while using " poorly performing " CAD schemes with the higher false-positive cueing rates reduced radiologists' performance [13]. "
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