Digital Compared with Screen-Film Mammography: Measures of Diagnostic Accuracy among Women Screened in the Ontario Breast Screening Program.
OBJECTIVE
To compare measures of diagnostic accuracy between large concurrent cohorts of women screened with digital computed radiography (CR), direct radiography (DR), and screen-film mammography (SFM).


METHODS
This study was approved by the University of Toronto Research Ethics Board; informed consent was not required. Three concurrent cohorts of women aged 50-74 years who were screened from 2008-2009 in the Ontario Breast Screening Program with SFM (487,334 screening examinations, 403,688 women), DR (254,758 screening examinations, 220,520 women), or CR (74,140 screening examinations, 64,210 women) were followed for 2 years or until breast cancer diagnosis. Breast cancers were classified as screening-detected or interval on the basis of the woman's final screening and assessment results. Interval cancer rate (per 10 000 negative screening examinations), sensitivity, and specificity were compared across the cohorts by using mixed-effects logistic regression analysis.


RESULTS
Interval cancer rates were higher, although not significantly so, for CR (15.2 per 10,000; 95% confidence interval [CI]: 12.8, 17.8) and were similar for DR (13.7 per 10,000; 95% CI: 12.4, 15.0) compared with SFM (13.0 per 10,000; 95% CI: 12.1, 13.9). For CR versus SFM, specificity was similar while sensitivity was significantly lower (odds ratio [OR] = 0.62; 95% CI: 0.47, 0.83; P = .001), particularly for invasive cancers detected at a rescreening examination, for women with breast density of less than 75%, for women with no family history, and for postmenopausal women. For DR versus SFM, sensitivity was similar while specificity was lower (OR = 0.92; 95% CI: 0.87, 0.98; P = .01), particularly for rescreening examinations, for women aged 60-74 years, for women with breast density of less than 75%, for women with a family history, and for women who were postmenopausal.


CONCLUSIONS
Given the 38% lower sensitivity of CR imaging systems compared with SFM, programs should assess the continued use of this technology for breast screening.
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Maegan V
MV
Prummel
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Derek
D
Muradali
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Rene
R
Shumak
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Vicky
V
Majpruz
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Patrick
P
Brown
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Hedy
H
Jiang
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Susan J
SJ
Done
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Martin J
MJ
Yaffe
From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.).
Anna M
AM
Chiarelli
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000379:methods*; D012042:Registries; D012307:Risk Factors