title: Reduction in false-positive results after introduction of digital mammography: analysis from four population-based breast cancer screening programs in Spain.
abstract: OBJECTIVE
  To evaluate the effect of the introduction of digital mammography on the recall rate, detection rate, false-positive rate, and rates of invasive procedures in a cohort of women from four population-based breast cancer screening programs in Spain.
  
  
  METHODS
  The study was approved by the ethics committee; informed consent was not required. A total of 242,838 mammograms (171,191 screen film [screen-film mammography group] and 71,647 digital [digital mammography group]) obtained in 103,613 women aged 45-69 years were included. False-positive results for any additional procedure and for invasive procedures, the breast cancer rate, and the positive predictive value in each group were compared by using Pearson χ(2) test. The effect of the mammographic technology used (screen-film or digital) on the false-positive results and cancer detection risk was evaluated with multivariate logistic regression models, adjusted according to women's and the screening program's characteristics and time trends.
  
  
  RESULTS
  The false-positive rate was higher for screen-film than for digital mammography (7.6% and 5.7%, respectively; P < .001). False-positive results after an invasive procedure were significantly higher for screen-film than for digital mammography (1.9% and 0.7%, respectively; P < .001). No significant differences were observed in the overall cancer detection rate between the two groups (0.45% and 0.43% in the screen-film and digital mammography groups, respectively; P = .59). The adjusted risk of a false-positive result was higher for screen-film than for digital mammography (odds ratio = 1.32). The adjusted risk was also lower for the digital mammography group when time trends were taken into account.
  
  
  CONCLUSIONS
  The lower false-positive risk with use of digital mammography should be taken into account when balancing the risks and benefits of breast cancer screening.
authors.affiliation: Health Services Evaluation and Clinical Epidemiology Department, IMIM-Hospital del Mar, CIBER Epidemiología y Salud Pública, Passeig Marítim 25-29, 08008 Barcelona, Spain. Msalaserra@hospitaldelmar.cat
authors.forename: Maria
authors.initials: M
authors.lastname: Sala
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas
authors.forename: Francesc
authors.initials: F
authors.lastname: Belvis
authors.forename: Mar
authors.initials: M
authors.lastname: Sánchez
authors.forename: Joana
authors.initials: J
authors.lastname: Ferrer
authors.forename: Josefa
authors.initials: J
authors.lastname: Ibañez
authors.forename: Rubén
authors.initials: R
authors.lastname: Román
authors.forename: Francisco
authors.initials: F
authors.lastname: Ferrer
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vega
authors.forename: Maria Soledad
authors.initials: MS
authors.lastname: Laso
authors.forename: Xavier
authors.initials: X
authors.lastname: Castells
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016009:Chi-Square Distribution; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000379:methods*; D008403:Mass Screening; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D013030:Spain / Q000453:epidemiology