Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates.
OBJECTIVE
To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme.


METHODS
Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed.


RESULTS
A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p < .001), with a significant increase in cancer detection (p = .010).


CONCLUSIONS
As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.
Bluekens
Adriana M J
AM
National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands. a.bluekens@lrcb.umcn.nl
Karssemeijer
Nico
N
Beijerinck
David
D
Deurenberg
Jan J M
JJ
van Engen
Ruben E
RE
Broeders
Mireille J M
MJ
den Heeten
Gerard J
GJ
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008327:Mammography / Q000706:statistics & numerical data* / Q000639:trends; D008403:Mass Screening / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D015995:Prevalence; D011856:Radiographic Image Enhancement / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends
Eur J Cancer. 2008 Apr;44(6):798-807
18353630
Radiology. 2004 Jul;232(1):197-204
15155893
Eur Radiol. 2002 Nov;12(11):2679-83
12386757
Eur Radiol. 2007 Aug;17(8):1931-42
17429645
Lancet. 2003 Apr 26;361(9367):1411-7
12727393
Radiology. 2009 Nov;253(2):353-8
19703851
Eur Radiol. 2008 Jan;18(1):183-91
17680246
Radiology. 2007 Jan;242(1):70-7
17185661
N Engl J Med. 2005 Oct 27;353(17):1773-83
16169887
Radiology. 2009 May;251(2):347-58
19401569
Eur J Radiol. 2007 Dec;64(3):419-25
17383841
Radiology. 2009 Jul;252(1):31-9
19420316
Lancet. 2003 Apr 26;361(9367):1405-10
12727392
AJR Am J Roentgenol. 2007 Oct;189(4):860-6
17885057