title: Digital compared with screen-film mammography: performance measures in concurrent cohorts within an organized breast screening program.
abstract: OBJECTIVE
  To evaluate the performance of digital direct radiography (DR) and computed radiography (CR) compared with that of screen-film mammography (SFM) in large concurrent cohorts.
  
  
  METHODS
  This study was approved by the University of Toronto Research Ethics Board and did not require informed consent. Concurrent cohorts of women aged 50-74 years screened with DR (n = 220 520), CR (n = 64 210), or SFM (n = 403 688) between 2008 and 2009 were identified and followed for 12 months. Performance was compared between cohorts, with SFM as the referent cohort. Associations were examined by using mixed-effect logistic regression.
  
  
  RESULTS
  The cancer detection rate was similar for DR (4.9 per 1000; 95% confidence interval [CI]: 4.7, 5.2) and SFM (4.8 per 1000; 95% CI: 4.7, 5.0); however, the rate was significantly lower for CR (3.4 per 1000; 95% CI: 3.0, 3.9) (odds ratio, 0.79; 95% CI: 0.68, 0.93). Recall rates were higher for DR (7.7%; 95% CI: 7.6%, 7.8%) and lower for CR (6.6%; 95% CI: 6.5%, 6.7%) than for SFM (7.4%; 95% CI: 7.3%, 7.5%). Positive predictive value was lower for CR (5.2%; 95% CI: 4.7%, 5.8%) than for SFM (6.6%; 95% CI: 6.4%, 6.8%); however, the adjusted odds were not significant.
  
  
  CONCLUSIONS
  Although DR is equivalent to SFM for breast screening among women aged 50-74 years, the cancer detection rate was lower for CR. Screening programs should monitor the performance of CR separately and may consider informing women of the potentially lower cancer detection rates.
authors.affiliation: Department of Prevention and Cancer Control, Cancer Care Ontario, 620 University Ave, Toronto, ON, Canada. anna.chiarelli@cancercare.on.ca
authors.forename: Anna M
authors.initials: AM
authors.lastname: Chiarelli
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Edwards
authors.forename: Maegan V
authors.initials: MV
authors.lastname: Prummel
authors.forename: Derek
authors.initials: D
authors.lastname: Muradali
authors.forename: Vicky
authors.initials: V
authors.lastname: Majpruz
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Done
authors.forename: Patrick
authors.initials: P
authors.lastname: Brown
authors.forename: Rene S
authors.initials: RS
authors.lastname: Shumak
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Yaffe
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D015588:Observer Variation; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014962:X-Ray Film / Q000706:statistics & numerical data*