title: Impact of transition from analog screening mammography to digital screening mammography on screening outcome in The Netherlands: a population-based study.
abstract: BACKGROUND
  Full-field digital mammography (FFDM) has replaced screen-film mammography (SFM) in most breast screening programs. We analyzed the impact of this replacement on the screening outcome.
  
  
  METHODS
  The study population consisted of a consecutive series of 60 770 analog and 63 182 digital screens. During a 1-year follow-up, we collected breast imaging reports, biopsy results and surgical reports of all the referred women.
  
  
  RESULTS
  The referral rate and the cancer detection rate at FFDM were, respectively, 3.0% and 6,6‰, compared with 1.5% (P < 0.001) and 4.9‰ (P < 0.001) at SFM. Positive predictive values of referral and percutaneous biopsies were lower at FFDM, respectively, 21.9% versus 31.6% (P < 0.001) and 42.9% versus 62.8% (P < 0.001). Per 1000 screened women, there was a significant increase with FFDM versus SFM in the detection rate of low- and intermediate-grade ductal carcinoma in situ (DCIS) (+0.7), invasive T1a-c cancers (+0.9), invasive ductal cancers (+0.9), low-grade (+1.1), node-negative invasive cancers (+1.2), estrogen-receptor or progesterone-receptor-positive invasive cancers (respectively, +0.9 and +1.1) and Her2/Neu-negative (+0.8) invasive cancers. Mastectomy rates were stable at 1.1 per 1,000 screens.
  
  
  CONCLUSIONS
  FFDM significantly increased the referral rate and cancer detection rate, at the expense of a lower positive predictive value of referral and biopsy. Extra tumors detected at FFDM were mostly low-intermediate grade DCIS and smaller invasive tumors, of more favorable tumor characteristics. Mastectomy rates were not increased in the FFDM population, while increased over-diagnosis cannot be excluded.
authors: Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands. Electronic address: joost.nederend@cze.nl.
authors: J
authors: J
authors: Nederend
authors: Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
authors: L E M
authors: LEM
authors: Duijm
authors: Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Eindhoven, The Netherlands.
authors: M W J
authors: MWJ
authors: Louwman
authors: Expertise Center Transitions of Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
authors: J H
authors: JH
authors: Groenewoud
authors: Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands.
authors: A B
authors: AB
authors: Donkers-van Rossum
authors: Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
authors: A C
authors: AC
authors: Voogd
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008403:Mass Screening; D009426:Netherlands; D011856:Radiographic Image Enhancement / Q000379:methods*