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.
References
- 1. U.S. Food and Drug Administration. Mammography Quality Standards Act and Program. Accessed at www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/default.htm on 17 October 2010. Google Scholar
- 2.
Pisano ED ,Gatsonis C ,Hendrick E ,Yaffe M ,Baum JK ,Acharyya S ,et al ;Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group . Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 2005;353:1773-83. [PMID:16169887 ] CrossrefMedlineGoogle Scholar - 3.
Pisano ED ,Hendrick RE ,Yaffe MJ ,Baum JK ,Acharyya S ,Cormack JB ,et al ;DMIST Investigators Group . Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology. 2008;246:376-83. [PMID:18227537 ] CrossrefMedlineGoogle Scholar - 4.
Lewin JM ,D'Orsi CJ ,Hendrick RE ,Moss LJ ,Isaacs PK ,Karellas A ,et al . Clinical comparison of full-field digital mammography and screen-film mammography for detection of breast cancer. AJR Am J Roentgenol. 2002;179:671-7. CrossrefMedlineGoogle Scholar - 5.
Skaane P . Studies comparing screen-film mammography and full-field digital mammography in breast cancer screening: updated review. Acta Radiol. 2009;50:3-14. [PMID:19037825 ] CrossrefMedlineGoogle Scholar - 6.
Skaane P ,Hofvind S ,Skjennald A . Randomized trial of screen-film versus full-field digital mammography with soft-copy reading in population-based screening program: follow-up and final results of Oslo II study. Radiology. 2007;244:708-17. [PMID:17709826 ] CrossrefMedlineGoogle Scholar - 7.
Sala M ,Comas M ,Macià F ,Martinez J ,Casamitjana M ,Castells X . Implementation of digital mammography in a population-based breast cancer screening program: effect of screening round on recall rate and cancer detection. Radiology. 2009;252:31-9. [PMID:19420316 ] CrossrefMedlineGoogle Scholar - 8.
Vinnicombe S ,PintoPereira SM ,McCormack VA ,Shiel S ,Perry N ,Dos Santos Silva IM . Full-field digital versus screen-film mammography: comparison within the UK breast screening program and systematic review of published data. Radiology. 2009;251:347-58. [PMID:19401569 ] CrossrefMedlineGoogle Scholar - 9.
Karssemeijer N ,Bluekens AM ,Beijerinck D ,Deurenberg JJ ,Beekman M ,Visser R ,et al . Breast cancer screening results 5 years after introduction of digital mammography in a population-based screening program. Radiology. 2009;253:353-8. [PMID:19703851 ] CrossrefMedlineGoogle Scholar - 10.
Ballard-Barbash R ,Taplin SH ,Yankaskas BC ,Ernster VL ,Rosenberg RD ,Carney PA ,et al . Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database. AJR Am J Roentgenol. 1997;169:1001-8. [PMID:9308451 ] CrossrefMedlineGoogle Scholar - 11.
Ernster VL ,Ballard-Barbash R ,Barlow WE ,Zheng Y ,Weaver DL ,Cutter G ,et al . Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst. 2002;94:1546-54. [PMID:12381707 ] CrossrefMedlineGoogle Scholar - 12.
American College of Radiology . The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). 4th ed. Reston, VA: American Coll Radiology; 2003. Google Scholar - 13.
Yankaskas BC ,Taplin SH ,Ichikawa L ,Geller BM ,Rosenberg RD ,Carney PA ,et al . Association between mammography timing and measures of screening performance in the United States. Radiology. 2005;234:363-73. [PMID:15670994 ] CrossrefMedlineGoogle Scholar - 14.
American Joint Committee on Cancer . Manual for Staging of Cancer. 6th ed. Philadelphia: JB Lippincott; 2002. Google Scholar - 15.
Graubard BI ,Korn EL . Predictive margins with survey data. Biometrics. 1999;55:652-9. [PMID:11318229 ] CrossrefMedlineGoogle Scholar - 16.
Lane PW ,Nelder JA . Analysis of covariance and standardization as instances of prediction. Biometrics. 1982;38:613-21. [PMID:7171691 ] CrossrefMedlineGoogle Scholar - 17.
Kerlikowske K ,Miglioretti DL ,Ballard-Barbash R ,Weaver DL ,Buist DS ,Barlow WE ,et al . Prognostic characteristics of breast cancer among postmenopausal hormone users in a screened population. J Clin Oncol. 2003;21:4314-21. [PMID:14645420 ] CrossrefMedlineGoogle Scholar - 18.
Carney PA ,Miglioretti DL ,Yankaskas BC ,Kerlikowske K ,Rosenberg R ,Rutter CM ,et al . Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003;138:168-75. [PMID:12558355 ] LinkGoogle Scholar - 19.
Neuhaus JM ,Kalbfleisch JD . Between- and within-cluster covariate effects in the analysis of clustered data. Biometrics. 1998;54:638-45. [PMID:9629647 ] CrossrefMedlineGoogle Scholar - 20.
Ichikawa LE ,Barlow WE ,Anderson ML ,Taplin SH ,Geller BM ,Brenner RJ ;National Cancer Institute-sponsored Breast Cancer Surveillance Consortium . Time trends in radiologists' interpretive performance at screening mammography from the community-based Breast Cancer Surveillance Consortium, 1996-2004. Radiology. 2010;256:74-82. [PMID:20505059 ] CrossrefMedlineGoogle Scholar - 21.
Kerlikowske K . The mammogram that cried Wolfe [Editorial]. N Engl J Med. 2007;356:297-300. [PMID:17229958 ] CrossrefMedlineGoogle Scholar - 22.
Roubidoux MA ,Bailey JE ,Wray LA ,Helvie MA . Invasive cancers detected after breast cancer screening yielded a negative result: relationship of mammographic density to tumor prognostic factors. Radiology. 2004;230:42-8. [PMID:14695385 ] CrossrefMedlineGoogle Scholar - 23.
Buist DS ,Porter PL ,Lehman C ,Taplin SH ,White E . Factors contributing to mammography failure in women aged 40-49 years. J Natl Cancer Inst. 2004;96:1432-40. [PMID:15467032 ] CrossrefMedlineGoogle Scholar - 24.
Kerlikowske K ,Ichikawa L ,Miglioretti DL ,Buist DS ,Vacek PM ,Smith-Bindman R ,et al ;National Institutes of Health Breast Cancer Surveillance Consortium . Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst. 2007;99:386-95. [PMID:17341730 ] CrossrefMedlineGoogle Scholar - 25.
Farhat GN ,Walker R ,Buist DS ,Onega T ,Kerlikowske K . Changes in invasive breast cancer and ductal carcinoma in situ rates in relation to the decline in hormone therapy use. J Clin Oncol. 2010;28:5140-6. [PMID:21060026 ] CrossrefMedlineGoogle Scholar - 26.
Jiang Y ,Metz CE . BI-RADS data should not be used to estimate ROC curves [Editorial]. Radiology. 2010;256:29-31. [PMID:20574083 ] CrossrefMedlineGoogle Scholar - 27.
Kerlikowske K ,Grady D ,Barclay J ,Frankel SD ,Ominsky SH ,Sickles EA ,et al . Variability and accuracy in mammographic interpretation using the American College of Radiology Breast Imaging Reporting and Data System. J Natl Cancer Inst. 1998;90:1801-9. [PMID:9839520 ] CrossrefMedlineGoogle Scholar - 28.
Ciatto S ,Houssami N ,Apruzzese A ,Bassetti E ,Brancato B ,Carozzi F ,et al . Categorizing breast mammographic density: intra- and interobserver reproducibility of BI-RADS density categories. Breast. 2005;14:269-75. [PMID:16085233 ] CrossrefMedlineGoogle Scholar - 29.
Buist DS ,Anderson ML ,Haneuse SJ ,Sickles EA ,Smith RA ,Carney PA ,et al . Influence of annual interpretive volume on screening mammography performance in the United States. Radiology. 2011;259:72-84. [PMID:21343539 ] CrossrefMedlineGoogle Scholar - 30.
Smith-Bindman R ,Chu P ,Miglioretti DL ,Quale C ,Rosenberg RD ,Cutter G ,et al . Physician predictors of mammographic accuracy. J Natl Cancer Inst. 2005;97:358-67. [PMID:15741572 ] CrossrefMedlineGoogle Scholar
Author, Article and Disclosure Information
From University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California; Group Health Research Institute, Group Health Cooperative, University of Washington School of Public Health and Community Medicine, and University of Washington School of Medicine, Seattle, Washington; Health Promotion Research, University of Vermont, College of Medicine, Burlington, Vermont; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
and Applied Research Program, National Cancer Institute, Rockville, Maryland.
Acknowledgment: The authors thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. A list of BCSC investigators and procedures for requesting BCSC data for research purposes can be found at breastscreening.cancer.gov/.
Grant Support: By the National Cancer Institute–funded BCSC cooperative agreement (grants U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, and U01CA70040) and National Cancer Institute grants R03CA150007 and RC2CA148577. The collection of cancer data used in this study was supported in part by several state public health departments and cancer registries throughout the United States; for a full description of these sources, see breastscreening.cancer.gov/work/acknowledgement.html.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2769.
Reproducible Research Statement:Study protocol: Available from Dr. Kerlikowske (e-mail, Karla.
Corresponding Author: Karla Kerlikowske, MD, San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, 111A1, 4150 Clement Street, San Francisco, CA 94121; e-mail, Karla.
Current Author Addresses: Dr. Kerlikowske: San Francisco Veterans Affairs Medical Center, General Internal Medicine Section, 111A1, 4150 Clement Street, San Francisco, CA 94121.
Drs. Hubbard and Miglioretti: Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448.
Dr. Geller: Health Promotion Research, University of Vermont, 429AR4, One South Prospect Street, Elevator C-4426, Burlington, VT 05401-3444.
Dr. Yankaskas: Department of Radiology, CB #7515, MRI, University of North Carolina, 106 Mason Farm Road, Chapel Hill, NC 27599-7515.
Dr. Lehman: Seattle Cancer Care Alliance, 825 Eastlake Avenue East, G2-600, Seattle, WA 98109.
Dr. Taplin: National Cancer Institute, 6130 Executive Boulevard, Rockville, MD 20852-7344.
Dr. Sickles: Department of Radiology, Box 1667, UCSF Medical Center, San Francisco, CA 94143-1667.
Author Contributions: Conception and design: K. Kerlikowske, R.A. Hubbard, D.L. Miglioretti, B.M. Geller, B.C. Yankaskas, S. Taplin.
Analysis and interpretation of the data: K. Kerlikowske, R.A. Hubbard, D.L. Miglioretti, B.M. Geller, B.C. Yankaskas, E.A. Sickles.
Drafting of the article: K. Kerlikowske, R.A. Hubbard, B.M. Geller, B.C. Yankaskas, C.D. Lehman, S. Taplin.
Critical revision of the article for important intellectual content: K. Kerlikowske, R.A. Hubbard, B.M. Geller, B.C. Yankaskas, C.D. Lehman, S. Taplin, E.A. Sickles.
Final approval of the article: K. Kerlikowske, R.A. Hubbard, D.L. Miglioretti, B.M. Geller, B.C. Yankaskas, C.D. Lehman, S. Taplin, E.A. Sickles.
Statistical expertise: R.A. Hubbard, D.L. Miglioretti.
Obtaining of funding: K. Kerlikowske, D.L. Miglioretti, B.C. Yankaskas, S. Taplin.
Collection and assembly of data: K. Kerlikowske, R.A. Hubbard, D.L. Miglioretti, B.M. Geller, B.C. Yankaskas.
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
*All comments submitted after October 1, 2021 and selected for publication will be published online only.