Frequency, Digital Technology, and the Efficiency of Screening Mammography
Menées aux Etats-Unis, ces deux études évaluent, d'une part, la probabilité, cumulée sur 10 ans, d'avoir un résultat faussement positif lors d'une mammographie de dépistage d'un cancer du sein et, d'autre part, l'efficacité de la technologie numérique par comparaison avec la technologie analogique pour la détection des cancers du sein
The optimal frequency of screening mammography has been a topic of debate for decades. In the wake of the Greater New York Health Insurance Plan trial, which tested annual mammography plus breast physical examination, the Breast Cancer Detection Demonstration Project (conducted from 1973 to 1981 in 283 222 U.S. women aged 35 to 74 years from 29 U.S. centers) also adopted an annual screening schedule (1). In 1985, the Swedish Two-County Trial (2) provided the first evidence that mammography screening alone could reduce breast cancer mortality. The screening schedule in this trial was mammography 2 to 4 times every 24 months for women aged 40 to 49 years and every 33 months for women aged 50 to 74 years. Many argued that shorter screening intervals than those used in the Swedish trial would increase the capacity of screening to prevent advanced disease, especially in women younger than 50 years. Statistical modeling exercises (3) supported these arguments by suggesting that longer screening intervals would be associated with lower reductions in mortality.
The primary goal of mammography screening is to detect breast cancer when it is localized and curable, thus preventing advanced disease and breast cancer deaths. Screening efficiency is the balance between these health benefits (mainly the reduction in breast cancer mortality) versus the side effects and the costs of implementing screening. Although the issue of screening frequency is crucial for optimizing efficiency, few studies have addressed it properly. In this issue, Hubbard and …
Annals of Internal Medicine , éditorial, 2011