Impact of Full-Field Digital Mammography versus Film-Screen Mammography in Population Screening: a Meta-analysis
A partir d'une revue systématique de la littérature (24 études, plus de 16 millions examens de dépistage), cette méta-analyse évalue l'efficacité, du point de vue du taux de détection et de la réduction du taux de cancer de l'intervalle, de la mammographie numérique plein champ par rapport à la mammographie analogique
Background : Breast screening programs replaced film mammography with digital mammography, the effects of this practice shift in population screening on health outcomes can be measured through examination of cancer detection and interval cancer rates.
Methods : A systematic review and random effects meta-analysis were undertaken. Seven databases were searched for publications that compared film to digital mammography within the same population of asymptomatic women and reported cancer detection and/or interval cancer rates.
Results : The analysis included 24 studies with 16,583,743 screening examinations (10,968,843 film and 5,614,900 digital). The pooled difference in cancer detection rate showed an increase of 0.51 per 1,000 screens (95%CI: 0.19-0.83), greater relative increase for DCIS (25.2%, 95%CI: 17.4-33.5%) than invasive (4%, 95%CI: -3-13%), and a recall rate increase of 6.95 (95%CI: 3.47-10.42) per 1,000 screens after the transition from film to digital mammography. Seven studies (80.8% of screens) reported interval cancers: pooled difference showed no change in interval cancer rate with -0.02 per 1,000 screens (95%CI: -0.06-0.03). Restricting analysis to studies at low risk of bias resulted in findings consistent with the overall pooled results for all outcomes.
Conclusions : The increase in cancer detection following the practice shift to digital mammography did not translate into a reduction in the interval cancer rate. Recall rates were increased. These results suggest the transition from film to digital mammography did not result in health benefits for screened women. This analysis reinforces the need to carefully evaluate effects of future changes in technology, such as tomosynthesis, to ensure new technology leads to improved health outcomes and beyond technical gains.
Journal of the National Cancer Institute , article en libre accès, 2019