title: Comparative effectiveness of digital versus film-screen mammography in community practice in the United States: a cohort study.
abstract: BACKGROUND
  Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice.
  
  
  OBJECTIVE
  To determine whether the interpretive performance of digital and film-screen mammography differs.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Mammography facilities in the Breast Cancer Surveillance Consortium.
  
  
  METHODS
  329,261 women aged 40 to 79 years underwent 869 286 mammograms (231 034 digital; 638 252 film-screen).
  
  
  METHODS
  Invasive cancer or ductal carcinoma in situ diagnosed within 12 months of a digital or film-screen examination and calculation of mammography sensitivity, specificity, cancer detection rates, and tumor outcomes.
  
  
  RESULTS
  Overall, cancer detection rates and tumor characteristics were similar for digital and film-screen mammography, but the sensitivity and specificity of each modality varied by age, tumor characteristics, breast density, and menopausal status. Compared with film-screen mammography, the sensitivity of digital mammography was significantly higher for women aged 60 to 69 years (89.9% vs. 83.0%; P = 0.014) and those with estrogen receptor-negative cancer (78.5% vs. 65.8%; P = 0.016); borderline significantly higher for women aged 40 to 49 years (82.4% vs. 75.6%; P = 0.071), those with extremely dense breasts (83.6% vs. 68.1%; P = 0.051), and pre- or perimenopausal women (87.1% vs. 81.7%; P = 0.057); and borderline significantly lower for women aged 50 to 59 years (80.5% vs. 85.1%; P = 0.097). The specificity of digital and film-screen mammography was similar by decade of age, except for women aged 40 to 49 years (88.0% vs. 89.7%; P < 0.001).
  
  
  CONCLUSIONS
  Statistical power for subgroup analyses was limited.
  
  
  CONCLUSIONS
  Overall, cancer detection with digital or film-screen mammography is similar in U.S. women aged 50 to 79 years undergoing screening mammography. Women aged 40 to 49 years are more likely to have extremely dense breasts and estrogen receptor-negative tumors; if they are offered mammography screening, they may choose to undergo digital mammography to optimize cancer detection.
  
  
  BACKGROUND
  National Cancer Institute.
authors: University of California, San Francisco, USA. Karla.Kerlikowske@ucsf.edu
authors: Karla
authors: K
authors: Kerlikowske
authors: Rebecca A
authors: RA
authors: Hubbard
authors: Diana L
authors: DL
authors: Miglioretti
authors: Berta M
authors: BM
authors: Geller
authors: Bonnie C
authors: BC
authors: Yankaskas
authors: Constance D
authors: CD
authors: Lehman
authors: Stephen H
authors: SH
authors: Taplin
authors: Edward A
authors: EA
authors: Sickles
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001940:Breast / Q000033:anatomy & histology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging / Q000453:epidemiology; D044584:Carcinoma, Ductal / Q000000981:diagnostic imaging / Q000453:epidemiology; D057186:Comparative Effectiveness Research; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods* / Q000592:standards*; D008593:Menopause; D008875:Middle Aged; D011446:Prospective Studies; D011960:Receptors, Estrogen / Q000032:analysis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D014962:X-Ray Film
chemical_list: D011960:Receptors, Estrogen