Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment

A population based study from the Netherlands

J. Nederend, L.E. Duijm, M.W.J. Louwman, J.W. Coebergh, R.M.H. Roumen, P.N. Lohle, J.A. Roukema, M.J. Rutten, L.N. van Steenbergen, M.F. Ernst, F.H. Jansen, M.L. Plaisier, M.J.H.H. Hooijen, A.C. Voogd

Research output: Contribution to journalArticleScientificpeer-review

Abstract

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In most breast screening programmes screen-film mammography (SFM) has been replaced by full-field digital mammography (FFDM).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.Keywords: Breast cancer, Digital mammography, Interval cancer, Referral rate, Screening mammography, Sensitivity
Original languageEnglish
Pages (from-to)31-39
JournalEuropean Journal of Cancer
Volume50
Issue number1
DOIs
Publication statusPublished - 2014

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Netherlands
Neoplasms
Confidence Intervals

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Nederend, J. ; Duijm, L.E. ; Louwman, M.W.J. ; Coebergh, J.W. ; Roumen, R.M.H. ; Lohle, P.N. ; Roukema, J.A. ; Rutten, M.J. ; van Steenbergen, L.N. ; Ernst, M.F. ; Jansen, F.H. ; Plaisier, M.L. ; Hooijen, M.J.H.H. ; Voogd, A.C. / Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment : A population based study from the Netherlands. In: European Journal of Cancer. 2014 ; Vol. 50, No. 1. pp. 31-39.
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title = "Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment: A population based study from the Netherlands",
abstract = "IntroductionIn 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 methodsWe 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.ResultsThe 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).ConclusionFFDM 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.Keywords: Breast cancer, Digital mammography, Interval cancer, Referral rate, Screening mammography, Sensitivity",
author = "J. Nederend and L.E. Duijm and M.W.J. Louwman and J.W. Coebergh and R.M.H. Roumen and P.N. Lohle and J.A. Roukema and M.J. Rutten and {van Steenbergen}, L.N. and M.F. Ernst and F.H. Jansen and M.L. Plaisier and M.J.H.H. Hooijen and A.C. Voogd",
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year = "2014",
doi = "10.1016/j.ejca.2013.09.018",
language = "English",
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journal = "European Journal of Cancer",
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Nederend, J, Duijm, LE, Louwman, MWJ, Coebergh, JW, Roumen, RMH, Lohle, PN, Roukema, JA, Rutten, MJ, van Steenbergen, LN, Ernst, MF, Jansen, FH, Plaisier, ML, Hooijen, MJHH & Voogd, AC 2014, 'Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment: A population based study from the Netherlands', European Journal of Cancer, vol. 50, no. 1, pp. 31-39. https://doi.org/10.1016/j.ejca.2013.09.018

Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment : A population based study from the Netherlands. / Nederend, J.; Duijm, L.E.; Louwman, M.W.J.; Coebergh, J.W.; Roumen, R.M.H.; Lohle, P.N.; Roukema, J.A.; Rutten, M.J.; van Steenbergen, L.N.; Ernst, M.F.; Jansen, F.H.; Plaisier, M.L.; Hooijen, M.J.H.H.; Voogd, A.C.

In: European Journal of Cancer, Vol. 50, No. 1, 2014, p. 31-39.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment

T2 - A population based study from the Netherlands

AU - Nederend, J.

AU - Duijm, L.E.

AU - Louwman, M.W.J.

AU - Coebergh, J.W.

AU - Roumen, R.M.H.

AU - Lohle, P.N.

AU - Roukema, J.A.

AU - Rutten, M.J.

AU - van Steenbergen, L.N.

AU - Ernst, M.F.

AU - Jansen, F.H.

AU - Plaisier, M.L.

AU - Hooijen, M.J.H.H.

AU - Voogd, A.C.

N1 - Geen affiliatie met TiU

PY - 2014

Y1 - 2014

N2 - IntroductionIn 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 methodsWe 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.ResultsThe 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).ConclusionFFDM 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.Keywords: Breast cancer, Digital mammography, Interval cancer, Referral rate, Screening mammography, Sensitivity

AB - IntroductionIn 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 methodsWe 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.ResultsThe 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).ConclusionFFDM 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.Keywords: Breast cancer, Digital mammography, Interval cancer, Referral rate, Screening mammography, Sensitivity

U2 - 10.1016/j.ejca.2013.09.018

DO - 10.1016/j.ejca.2013.09.018

M3 - Article

VL - 50

SP - 31

EP - 39

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0964-1947

IS - 1

ER -