title: Does digital mammography suppose an advance in early diagnosis? Trends in performance indicators 6 years after digitalization.
abstract: OBJECTIVE
  To provide a complete evaluation of the long-term impact of full-field digital mammography (FFDM) on the improvement of early diagnosis in a population-based screening program.
  
  
  METHODS
  We included 82,961 screen-film mammograms (SFM) and 79,031 FFDM from women aged 50-69 screened biennially from 1995-2010 in Spain and followed-up to 2012. The first screening round of the program was excluded. Rates of cancer detection, interval cancer, tumoral characteristics and other quality indicators were compared between SFM and FFDM periods using the Chi-square test. Multivariate logistic regression models were fitted.
  
  
  RESULTS
  Detection of ductal carcinoma in situ (DCIS) significantly increased with FFDM (0.05 % vs 0.09 %; p = 0.010), along with the proportion of small invasive cancers (<20 mm) (69.37 % vs 78.90 %; p = 0.040). The false-positive rate decreased with FFDM (4.79 % vs 3.38 %; p < 0.001) without differences in the cancer detection rate (0.42 % vs 0.43 %; p = 0.685) or in the interval cancer rate (0.14 % vs 0.14 %; p = 0.816). Adjusted models showed a significant increase in the detection of DCIS in the FFDM periods.
  
  
  CONCLUSIONS
  Digitalization has supposed an improvement in early diagnosis because DCIS and small invasive cancers increased without a change in detection rate. Moreover, false-positive reduction without an increase in the interval cancer rate was confirmed.
authors.affiliation: Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg. Marítim 25-29, 08003, Barcelona, Spain, MSalaSerra@parcdesalutmar.cat.
authors.forename: Maria
authors.initials: M
authors.lastname: Sala
authors.forename: Laia
authors.initials: L
authors.lastname: Domingo
authors.forename: Francesc
authors.initials: F
authors.lastname: Macià
authors.forename: Mercè
authors.initials: M
authors.lastname: Comas
authors.forename: Andrea
authors.initials: A
authors.lastname: Burón
authors.forename: Xavier
authors.initials: X
authors.lastname: Castells
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods* / Q000592:standards; D008403:Mass Screening; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D013030:Spain