Digital mammography improves population-based breast cancer screening

October 2, 2012, Radiological Society of North America

New research from the Netherlands shows that the switch from screen film mammography (SFM) to digital mammography (DM) in large, population-based breast cancer screening programs improves the detection of life-threatening cancer without significantly increasing detection of clinically insignificant disease. Results of the study are published online in the journal Radiology.

DM's higher sensitivity at detecting raised concerns that its introduction into screening programs would increase the diagnosis of clinically unimportant cancers—cancers that, if left undetected and therefore untreated, would never have surfaced clinically in the person's lifetime. Data analysis showed an increased incidence of in situ (DCIS), a precursor for , in the years after the introduction of population-based screening with DM. The development of low-grade DCIS can extend over more than three decades; however, high-grade DCIS is associated with far more rapid .

"More DCIS and invasive cancers are detected with the use of DM in breast cancer screening compared to SFM," said Adriana M.J. Bluekens, M.D., from the National Expert and Training Centre for Breast Cancer Screening in Nijmegen and St. Elisabeth Hospital in Tilburg, both in the Netherlands. "In the mix of low- to high-grade DCIS , there is no shift to the detection of low-grade lesions in digital screening. Instead of this, we noticed a larger amount of high-grade lesions, which are regarded as precursors of high-grade invasive tumors."

To learn more about the impact of DM on screening programs, Dutch researchers compared it with SFM in screening mammograms performed between 2003 and 2007. Recall was indicated in 18,896 cases out of almost two million studied, and 6,410 women were diagnosed with breast cancer. As expected, DM had a higher initial sensitivity for , with a detection rate per thousand of 6.8, compared with 5.6 for SFM.

Detection of high-grade DCIS with DM was 58.5 percent, compared with 50.5 percent for SFM.

"This gain is largely due to enhanced depiction of microcalcifications with DM resulting in improved detection of DCIS and invasive carcinoma with an intraductal component," Dr. Bluekens said.

The initial recall rate was higher with DM: 4.4 percent, compared with 2.6 percent for SFM. However, the transition to did not result in a disproportionate increase in low-grade DCIS lesions, which are linked to possible overdiagnosis.

The findings provide further evidence of the benefits of population-based programs that use DM, according to Dr. Bluekens.

"The follow-up period of the different digital screening programs is not sufficiently long enough to analyze mortality effect separately from that of SFM," she noted. "However, surrogate parameters, such as stage distribution and tumor characteristics of DM-detected cancers, do indicate the continuation of mortality decrease with the transformation of SFM to DM in screening programs."

Researchers cautioned that the results were based on analysis of data from the Dutch screening program, with its focus on balancing the rates of detection, recall and false-positives. Numbers from the U.S. screening program, which focuses more on a high detection rate, would likely be different.

Explore further: Researcher calls for mammograms to be tailored to patient

Related Stories

Researcher calls for mammograms to be tailored to patient

September 30, 2011
Mammograms are not one-size-fits-all, says noted breast cancer researcher Karla Kerlikowske, MD, of the University of California, San Francisco (UCSF). Rather, they should be customized based on a woman’s age, breast ...

Mammography-detected breast cancer in 40-49 year-olds has better prognosis

February 22, 2012
Based on a study of nearly 2,000 breast cancer patients, researchers at the Swedish Cancer Institute in Seattle say that, in women between the ages of 40 and 49, breast cancers detected by mammography have a better prognosis. ...

Breast density tied to specific types of breast cancer

July 27, 2011
Women with breasts that appear dense on mammograms are at a higher risk of breast cancer and their tumors are more likely to have certain aggressive characteristics than women with less dense breasts, according to a study ...

Recommended for you

Dulling cancer therapy's double-edged sword

January 17, 2018
Researchers have discovered that killing cancer cells can actually have the unintended effect of fueling the proliferation of residual, living cancer cells, ultimately leading to aggressive tumor progression.

Researchers develop swallowable test to detect pre-cancerous Barrett's esophagus

January 17, 2018
Investigators at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center have developed a simple, swallowable test for early detection of Barrett's esophagus that offers promise ...

Scientists zoom in to watch DNA code being read

January 17, 2018
Scientists have unveiled incredible images of how the DNA code is read and interpreted—revealing new detail about one of the fundamental processes of life.

T-cells engineered to outsmart tumors induce clinical responses in relapsed Hodgkin lymphoma

January 16, 2018
WASHINGTON-(Jan. 16, 2018)-Tumors have come up with ingenious strategies that enable them to evade detection and destruction by the immune system. So, a research team that includes Children's National Health System clinician-researchers ...

Researchers identify new treatment target for melanoma

January 16, 2018
Researchers in the Perelman School of Medicine at the University of Pennsylvania have identified a new therapeutic target for the treatment of melanoma. For decades, research has associated female sex and a history of previous ...

More evidence of link between severe gum disease and cancer risk

January 16, 2018
Data collected during a long-term health study provides additional evidence for a link between increased risk of cancer in individuals with advanced gum disease, according to a new collaborative study led by epidemiologists ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.