Diagnostic performance of digital versus film mammography for breast-cancer screening.
BACKGROUND
Film mammography has limited sensitivity for the detection of breast cancer in women with radiographically dense breasts. We assessed whether the use of digital mammography would avoid some of these limitations.


METHODS
A total of 49,528 asymptomatic women presenting for screening mammography at 33 sites in the United States and Canada underwent both digital and film mammography. All relevant information was available for 42,760 of these women (86.3 percent). Mammograms were interpreted independently by two radiologists. Breast-cancer status was ascertained on the basis of a breast biopsy done within 15 months after study entry or a follow-up mammogram obtained at least 10 months after study entry. Receiver-operating-characteristic (ROC) analysis was used to evaluate the results.


RESULTS
In the entire population, the diagnostic accuracy of digital and film mammography was similar (difference between methods in the area under the ROC curve, 0.03; 95 percent confidence interval, -0.02 to 0.08; P=0.18). However, the accuracy of digital mammography was significantly higher than that of film mammography among women under the age of 50 years (difference in the area under the curve, 0.15; 95 percent confidence interval, 0.05 to 0.25; P=0.002), women with heterogeneously dense or extremely dense breasts on mammography (difference, 0.11; 95 percent confidence interval, 0.04 to 0.18; P=0.003), and premenopausal or perimenopausal women (difference, 0.15; 95 percent confidence interval, 0.05 to 0.24; P=0.002).


CONCLUSIONS
The overall diagnostic accuracy of digital and film mammography as a means of screening for breast cancer is similar, but digital mammography is more accurate in women under the age of 50 years, women with radiographically dense breasts, and premenopausal or perimenopausal women. (ClinicalTrials.gov number, NCT00008346.)
Pisano
Etta D
ED
Department of Radiology, the Biomedical Research Imaging Center, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA. etta_pisano@med.unc.edu
Gatsonis
Constantine
C
Hendrick
Edward
E
Yaffe
Martin
M
Baum
Janet K
JK
Acharyya
Suddhasatta
S
Conant
Emily F
EF
Fajardo
Laurie L
LL
Bassett
Lawrence
L
D'Orsi
Carl
C
Jong
Roberta
R
Rebner
Murray
M
D000328:Adult; D000367:Age Factors; D019540:Area Under Curve; D001940:Breast / Q000033:anatomy & histology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D047648:Perimenopause; D017697:Premenopause; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D012680:Sensitivity and Specificity