title: Screen-detected versus interval cancers: Effect of imaging modality and breast density in the Flemish Breast Cancer Screening Programme.
abstract: OBJECTIVE
  To investigate if direct radiography (DR) performs better than screen-film mammography (SF) and computed radiography (CR) in dense breasts in a decentralized organised Breast Cancer Screening Programme. To this end, screen-detected versus interval cancers were studied in different BI-RADS density classes for these imaging modalities.
  
  
  METHODS
  The study cohort consisted of 351,532 women who participated in the Flemish Breast Cancer Screening Programme in 2009 and 2010. Information on screen-detected and interval cancers, breast density scores of radiologist second readers, and imaging modality was obtained by linkage of the databases of the Centre of Cancer Detection and the Belgian Cancer Registry.
  
  
  RESULTS
  Overall, 67% of occurring breast cancers are screen detected and 33% are interval cancers, with DR performing better than SF and CR. The interval cancer rate increases gradually with breast density, regardless of modality. In the high-density class, the interval cancer rate exceeds the cancer detection rate for SF and CR, but not for DR.
  
  
  CONCLUSIONS
  DR is superior to SF and CR with respect to cancer detection rates for high-density breasts. To reduce the high interval cancer rate in dense breasts, use of an additional imaging technique in screening can be taken into consideration.
  
  
  CONCLUSIONS
  • Interval cancer rate increases gradually with breast density, regardless of modality. • Cancer detection rate in high-density breasts is superior in DR. • IC rate exceeds CDR for SF and CR in high-density breasts. • DR performs better in high-density breasts for third readings and false-positives.
authors.affiliation: Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium. Lore.Timmermans@UGent.be.
authors.forename: Lore
authors.initials: L
authors.lastname: Timmermans
authors.affiliation: Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Bleyen
authors.affiliation: Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium.
authors.forename: Klaus
authors.initials: K
authors.lastname: Bacher
authors.affiliation: Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Van Herck
authors.affiliation: Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Kim
authors.initials: K
authors.lastname: Lemmens
authors.affiliation: Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Ongeval
authors.affiliation: Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Andre
authors.initials: A
authors.lastname: Van Steen
authors.affiliation: Centrum voor Kankeropsporing, Bruges, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Martens
authors.affiliation: Belgian Cancer Registry, Brussels, Belgium.
authors.forename: Isabel
authors.initials: I
authors.lastname: De Brabander
authors.affiliation: Dienst Kankerpreventie, UZ Brussel, Brussels, Belgium.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Goossens
authors.affiliation: Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium.
authors.forename: Hubert
authors.initials: H
authors.lastname: Thierens
mesh_terms: D000368:Aged; D001530:Belgium; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D005387:Finland; D006801:Humans; D008327:Mammography / Q000379:methods* / Q000592:standards; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies
keywords: Breast cancer screening; Breast density; Digital mammography; Interval cancers; Screen-film mammography