title: Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment - a population based study from the Netherlands.
abstract: BACKGROUND
  In most breast screening programmes screen-film mammography (SFM) has been replaced by full-field digital mammography (FFDM). We compared interval cancer characteristics at SFM and FFDM screening mammography.
  
  
  METHODS
  We included all 297 screen-detected and 104 interval cancers in 60,770 SFM examinations and 427 screen-detected and 124 interval cancers in 63,182 FFDM examinations, in women screened in the period 2008-2010. Breast imaging reports, biopsy results and surgical reports of all cancers were collected. Two radiologists reviewed prior and diagnostic mammograms of all interval cancers. They determined breast density, described mammographic abnormalities and classified interval cancers as missed, showing a minimal sign abnormality or true negative.
  
  
  RESULTS
  The referral rate and cancer detection at SFM were 1.5% and 4.9‰ respectively, compared to 3.0% (p<0.001) and 6.6‰ (p<0.001) at FFDM. Screening sensitivity was 74.1% at SFM (297/401, 95% confidence interval (CI)=69.8-78.4%) and 77.5% at FFDM (427/551, 95% CI=74.0-81.0%). Significantly more interval cancers were true negative at prior FFDM than at prior SFM screening mammography (65.3% (81/124) versus 47.1% (49/104), p=0.02). For interval cancers following SFM or FFDM screening mammography, no significant differences were observed in breast density or mammographic abnormalities at the prior screen, tumour size, lymph node status, receptor status, Nottingham tumour grade or surgical treatment (mastectomy versus breast conserving therapy).
  
  
  CONCLUSIONS
  FFDM resulted in a significantly higher cancer detection rate, but sensitivity was similar for SFM and FFDM. Interval cancers are more likely to be true negative at prior FFDM than at prior SFM screening mammography, whereas their tumour characteristics and type of surgical treatment are comparable.
authors.affiliation: Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands. Electronic address: joost.nederend@cze.nl.
authors.forename: Joost
authors.initials: J
authors.lastname: Nederend
authors.affiliation: Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands.
authors.forename: Lucien E M
authors.initials: LE
authors.lastname: Duijm
authors.affiliation: Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands.
authors.forename: Marieke W J
authors.initials: MW
authors.lastname: Louwman
authors.affiliation: Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Coebergh
authors.affiliation: Department of Surgery, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands.
authors.forename: Rudi M H
authors.initials: RM
authors.lastname: Roumen
authors.affiliation: Department of Radiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Lohle
authors.affiliation: Department of Surgery, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Roukema
authors.affiliation: Department of Radiology, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands.
authors.forename: Matthieu J C M
authors.initials: MJ
authors.lastname: Rutten
authors.affiliation: Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands.
authors.forename: Liza N
authors.initials: LN
authors.lastname: van Steenbergen
authors.affiliation: Department of Surgery, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands.
authors.forename: Miranda F
authors.initials: MF
authors.lastname: Ernst
authors.affiliation: Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands.
authors.forename: Frits H
authors.initials: FH
authors.lastname: Jansen
authors.affiliation: Department of Radiology, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands.
authors.forename: Menno L
authors.initials: ML
authors.lastname: Plaisier
authors.affiliation: Department of Radiology, St. Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The Netherlands.
authors.forename: Marianne J H H
authors.initials: MJ
authors.lastname: Hooijen
authors.affiliation: Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229 HA Maastricht, The Netherlands.
authors.forename: Adri C
authors.initials: AC
authors.lastname: Voogd
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D055088:Early Detection of Cancer / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008327:Mammography / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands
keywords: Breast cancer; Digital mammography; Interval cancer; Referral rate; Screening mammography; Sensitivity