Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment – A population based study from the Netherlands
Menée aux Pays-Bas à partir de l'analyse de 123 952 mammographies réalisées entre 2008 et 2010, cette étude compare la performance, du point de vue du taux de détection du cancer du sein et de la sensibilité, d'une mammographie analogique (297 cancers détectés, 104 cancers de l'intervalle) et d'une mammographie numérique (427 cancers détectés, 124 cancers de l'intervalle), puis analyse l'impact de la mammographie numérique sur les caractéristiques des cancers de l'intervalle et les stratégies thérapeutiques mises en place
Introduction : In most breast screening programmes screen-film mammography (SFM) has been replaced by full-field digital mammography (FFDM). We compared interval cancer characteristics at SFM and FFDM screening mammography.
Patients and methods : We included all 297 screen-detected and 104 interval cancers in 60,770 SFM examinations and 427 screen-detected and 124 interval cancers in 63,182 FFDM examinations, in women screened in the period 2008–2010. Breast imaging reports, biopsy results and surgical reports of all cancers were collected. Two radiologists reviewed prior and diagnostic mammograms of all interval cancers. They determined breast density, described mammographic abnormalities and classified interval cancers as missed, showing a minimal sign abnormality or true negative.
Results : The referral rate and cancer detection at SFM were 1.5% and 4.9‰ respectively, compared to 3.0% (p < 0.001) and 6.6‰ (p < 0.001) at FFDM. Screening sensitivity was 74.1% at SFM (297/401, 95% confidence interval (CI) = 69.8–78.4%) and 77.5% at FFDM (427/551, 95% CI = 74.0–81.0%). Significantly more interval cancers were true negative at prior FFDM than at prior SFM screening mammography (65.3% (81/124) versus 47.1% (49/104), p = 0.02). For interval cancers following SFM or FFDM screening mammography, no significant differences were observed in breast density or mammographic abnormalities at the prior screen, tumour size, lymph node status, receptor status, Nottingham tumour grade or surgical treatment (mastectomy versus breast conserving therapy).
Conclusion : FFDM resulted in a significantly higher cancer detection rate, but sensitivity was similar for SFM and FFDM. Interval cancers are more likely to be true negative at prior FFDM than at prior SFM screening mammography, whereas their tumour characteristics and type of surgical treatment are comparable.
European Journal of Cancer , résumé, 2012