title: Comparing sensitivity and specificity of screening mammography in the United States and Denmark.
abstract: Delivery of screening mammography differs substantially between the United States (US) and Denmark. We evaluated whether there are differences in screening sensitivity and specificity. We included screens from women screened at age 50-69 years during 1996-2008/2009 in the US Breast Cancer Surveillance Consortium (BCSC) (n = 2,872,791), and from two population-based mammography screening programs in Denmark (Copenhagen, n = 148,156 and Funen, n = 275,553). Women were followed-up for 1 year. For initial screens, recall rate was significantly higher in BCSC (17.6%) than in Copenhagen (4.3%) and Funen (3.1%). Sensitivity was fairly similar in BCSC (91.8%) and Copenhagen (90.5%) and Funen (92.5%). At subsequent screens, recall rates were 8.8%, 1.8% and 1.4% in BCSC, Copenhagen and Funen, respectively. The BCSC sensitivity (82.3%) was lower compared with that in Copenhagen (88.9%) and Funen (86.9%), but when stratified by time since last screen, the sensitivity was similar. For both initial and subsequent screenings, the specificity of screening in BCSC (83.2% and 91.6%) was significantly lower than that in Copenhagen (96.6% and 98.8%) and Funen (97.9% and 99.2%). By taking time since last screen into account, it was found that American and Danish women had the same probability of having their asymptomatic cancers detected at screening. However, the majority of women free of asymptomatic cancers experienced more harms in terms of false-positive findings in the US than in Denmark.
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
authors.forename: Katja
authors.initials: K
authors.lastname: Kemp Jacobsen
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: O'Meara
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: Dustin
authors.initials: D
authors.lastname: Key
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: S M Buist
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.|General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA.
authors.forename: Karla
authors.initials: K
authors.lastname: Kerlikowske
authors.affiliation: Center of Diagnostic Imaging, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Ilse
authors.initials: I
authors.lastname: Vejborg
authors.affiliation: Department of Surgery, University of Vermont, Burlington, VT, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
authors.forename: Elsebeth
authors.initials: E
authors.lastname: Lynge
authors.affiliation: Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
authors.forename: My
authors.initials: M
authors.lastname: von Euler-Chelpin
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
keywords: Breast Cancer Surveillance Consortium; mammographic performance; mass screening; sensitivity; specificity