Breast cancer screening results 5 years after introduction of digital mammography in a population-based screening program.
OBJECTIVE
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Karssemeijer
Nico
N
Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grootteplein 10, 6500 HB Nijmegen, the Netherlands. n.karssemeijer@rad.umcn.nl
Bluekens
Adriana M
AM
Beijerinck
David
D
Deurenberg
Jan J
JJ
Beekman
Matthijs
M
Visser
Roelant
R
van Engen
Ruben
R
Bartels-Kortland
Annemieke
A
Broeders
Mireille J
MJ
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted; D014963:X-Ray Intensifying Screens