title: Calcifications in digital mammographic screening: improvement of early detection of invasive breast cancers?
abstract: OBJECTIVE
  To evaluate the relevance of calcifications for invasive breast cancer detection in population-based digital mammographic screening.
  
  
  METHODS
  This study was approved by an independent ethics committee, and no additional informed consent was required. Prospectively documented radiologic cancer features were correlated with pathologic characteristics in 241 breast malignancies diagnosed in 24067 participating women aged 50-69 years (part of the digital German Screening Program; initial screening rate, 92%; detection rate [DR], 1.0%; recall rate [RR], 7.5%). The rates of invasive cancers detected on the basis of calcifications were analyzed against pathologic tumor categories (pT categories) and histologic grades. For comparison of the study data with results of analog screening, data from the literature regarding calcification-specific RR, DR, and positive predictive value for recall (PPV(1)) were calculated.
  
  
  RESULTS
  The calcification-specific RR was 1.7% (416 of 24067). The calcification-specific DR for invasive cancer was 0.12% (29 of 24067), and the PPV(1) was 7.0% (29 of 416). Of all malignancies detected on the basis of calcification, 38% (29 of 77) were invasive. pT1 cancers showed an inverse association between tumor size and rate of detection on the basis of calcification; differences in rates among pT1 subcategories were statistically significant (P < .001). The proportion of grade 1 pT1 cancers detected on the basis of calcification (eight of 27) did not differ significantly from that of cancers detected on the basis of other radiologic features (46 of 108, P = .24). The calcification-specific invasive cancer DR was significantly higher for digital than for analog mammography.
  
  
  CONCLUSIONS
  One-third of malignancies detected on the basis of calcifications only are invasive cancers. They tend to be smaller but not less aggressive than invasive cancers detected on the basis of other features. Compared with published results of analog screening, digital screening offers the potential to increase the rate of invasive cancers detected on the basis of calcifications in population-based mammographic screening.
authors.affiliation: Department of Clinical Radiology and Reference Center for Mammography, University Hospital Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Weigel
authors.forename: Thomas
authors.initials: T
authors.lastname: Decker
authors.forename: Eberhard
authors.initials: E
authors.lastname: Korsching
authors.forename: Daniela
authors.initials: D
authors.lastname: Hungermann
authors.forename: Werner
authors.initials: W
authors.lastname: Böcker
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000473:pathology; D016009:Chi-Square Distribution; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018709:Statistics, Nonparametric