title: Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates.
abstract: 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.
authors.affiliation: National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands. a.bluekens@lrcb.umcn.nl
authors.forename: Adriana M J
authors.initials: AM
authors.lastname: Bluekens
authors.forename: Nico
authors.initials: N
authors.lastname: Karssemeijer
authors.forename: David
authors.initials: D
authors.lastname: Beijerinck
authors.forename: Jan J M
authors.initials: JJ
authors.lastname: Deurenberg
authors.forename: Ruben E
authors.initials: RE
authors.lastname: van Engen
authors.forename: Mireille J M
authors.initials: MJ
authors.lastname: Broeders
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: den Heeten
mesh_terms: 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
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