title: Digital versus screen-film mammography: impact of mammographic density and hormone therapy on breast cancer detection.
abstract: Most studies that have examined the effects of mammographic density and hormone therapy use on breast cancer detection have included screen-film mammography. This study further examines this association in post-menopausal women screened by digital mammography. Approved by the University of Toronto Research Ethics Board, this study identified 688,418 women of age 50-74 years screened with digital or screen-film mammography from 2008 to 2009 within the Ontario Breast Screening Program. Of 2993 eligible women with invasive breast cancer, 2450 were contacted and 1421 participated (847 screen-film mammography, 574 digital direct radiography). Mammographic density was measured by study radiologists using the standard BI-RADS classification system and by a computer-assisted method. Information on hormone therapy use was collected by a telephone-administered questionnaire. Logistic regression and two-tailed tests for significance evaluated associations between factors and detection method by mammography type. Women with >75 % radiologist-measured mammographic density compared to those with <25 % were more likely to be diagnosed with an interval than screen-detected cancer, with the difference being greater for those screened with screen-film (OR = 6.40, 95 % CI 2.30-17.85) than digital mammography (OR = 2.41, 95 % CI 0.67-8.58) and aged 50-64 years screened with screen-film mammography (OR = 10.86, 95 % CI 2.96-39.57). Recent former hormone therapy users were also at an increased risk of having an interval cancer with the association being significant for women screened with digital mammography (OR = 2.08, 95 % CI 1.17-3.71). Breast screening using digital mammography lowers the risk of having an interval cancer for post-menopausal women aged 50-64 with greater mammographic density.
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada. anna.chiarelli@cancercare.on.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. anna.chiarelli@cancercare.on.ca.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Chiarelli
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada.
authors.forename: Maegan V
authors.initials: MV
authors.lastname: Prummel
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Muradali
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada.
authors.forename: Rene S
authors.initials: RS
authors.lastname: Shumak
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada.
authors.forename: Vicky
authors.initials: V
authors.lastname: Majpruz
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brown
authors.affiliation: Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada.
authors.forename: Hedy
authors.initials: H
authors.lastname: Jiang
authors.affiliation: The Campbell Family Institute for Breast Cancer Research and Laboratory Medicine Program, University Health Network, Toronto, Canada.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Done
authors.affiliation: Women's College Hospital, Sunnybrook Health Sciences Centre, Toronto, Canada.|Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Yaffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D055088:Early Detection of Cancer; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D006801:Humans; D042361:Mammary Glands, Human / Q000002:abnormalities* / Q000473:pathology*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D017698:Postmenopause; D011856:Radiographic Image Enhancement; D012042:Registries; D012307:Risk Factors
keywords: Digital mammography; Hormone therapy use; Mammographic density; Post-menopausal; Screen-film mammography; Screening programme