title: Reported mammographic density: film-screen versus digital acquisition.
abstract: OBJECTIVE
  To test the hypothesis that American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories for breast density reported by radiologists are lower when digital mammography is used than those reported when film-screen (FS) mammography is used.
  
  
  METHODS
  This study was institutional review board approved and HIPAA compliant. Demographic data, risk factors, and BI-RADS breast density categories were collected from five mammography registries that were part of the Breast Cancer Surveillance Consortium. Active, passive, or waiver of consent was obtained for all participants. Women aged 40 years and older who underwent at least two screening mammographic examinations less than 36 months apart between January 1, 2000, and December 31, 2009, were included. Women with prior breast cancer, augmentation, or use of agents known to affect density were excluded. The main sample included 89 639 women with both FS and digital mammograms. The comparison group included 259 046 women with two FS mammograms and 87 066 women with two digital mammograms. BI-RADS density was cross-tabulated according to the order in which the two types of mammogram were acquired and by the first versus second interpretation.
  
  
  RESULTS
  Regardless of acquisition method, the percentage of women with a change in density from one reading to the next was similar. Breast density was lower in 19.8% of the women who underwent FS before digital mammography and 17.1% of those who underwent digital before FS mammography. Similarly, lower density classifications were reported on the basis of the second mammographic examination regardless of acquisition method (15.8%-19.8%). The percentage of agreement between density readings was similar regardless of mammographic types paired (67.3%-71.0%).
  
  
  CONCLUSIONS
  The study results showed no difference in reported BI-RADS breast density categories according to acquisition method. Reported BI-RADS density categories may be useful in the development of breast cancer risk models in which FS, digital, or both acquisition methods are used.
authors.affiliation: Department of Radiology, University of Virginia, Box 800170, Charlottesville, VA 22908, USA. ah7w@virginia.edu
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Harvey
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Gard
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Yankaskas
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.forename: Berta A
authors.initials: BA
authors.lastname: Geller
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Onega
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D014962:X-Ray Film / Q000706:statistics & numerical data*