title: Transition from film to digital mammography: impact for breast cancer screening through the national breast and cervical cancer early detection program.
abstract: BACKGROUND
  The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides mammograms and diagnostic services for low-income, uninsured women aged 40-64 years. Mammography facilities within the NBCCEDP gradually shifted from plain-film to digital mammography. The purpose of this study is to assess the impact of replacing film with digital mammography on health effects (deaths averted, life-years gained [LYG]); costs (for screening and diagnostics); and number of women reached.
  
  
  METHODS
  NBCCEDP 2010 data and data representative of the program's target population were used in two established microsimulation models. Models simulated observed screening behavior including different screening intervals (annual, biennial, irregular) and starting ages (40, 50 years) for white, black, and Hispanic women. Model runs were performed in 2012.
  
  
  RESULTS
  The models predicted 8.0-8.3 LYG per 1,000 film screens for black women, 5.9-7.5 for white women, and 4.0-4.5 for Hispanic women. For all race/ethnicity groups, digital mammography had more LYG than film mammography (2%-4%), but had higher costs (34%-35%). Assuming a fixed budget, 25%-26% fewer women could be served, resulting in 22%-24% fewer LYG if all mammograms were converted to digital. The loss in LYG could be reversed to an 8%-13% increase by only including biennial screening.
  
  
  CONCLUSIONS
  Digital could result in slightly more LYG than film mammography. However, with a fixed budget, fewer women may be served with fewer LYG. Changes in the program, such as only including biennial screening, will increase LYG/screen and could offset the potential decrease in LYG when shifting to digital mammography.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam. Electronic address: n.vanravesteyn@erasmusmc.nl.
authors.forename: Nicolien T
authors.initials: NT
authors.lastname: van Ravesteyn
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam; Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: van Lier
authors.affiliation: Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein School of Medicine, Bronx, New York.
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Donatus U
authors.initials: DU
authors.lastname: Ekwueme
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Janet
authors.initials: J
authors.lastname: Royalty
authors.affiliation: CDC, Atlanta, Georgia.
authors.forename: Jacqueline W
authors.initials: JW
authors.lastname: Miller
authors.affiliation: Department of Oncology, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, District of Columbia.
authors.forename: Aimee M
authors.initials: AM
authors.lastname: Near
authors.affiliation: Statistical Research and Application Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Cronin
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam.
authors.forename: Eveline A M
authors.initials: EA
authors.lastname: Heijnsdijk
authors.affiliation: Department of Oncology, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, District of Columbia.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D016208:Databases, Factual; D003936:Diagnosis, Computer-Assisted; D004059:Diffusion of Innovation; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged