Implementation of Digital Mammography in a Population-based Breast Cancer Screening Program: Effect of Screening Round on Recall Rate and Cancer Detection

Sala, María; Comas, Mercè; Macià, Francesc; Martínez, Juan; Casamitjana, Montserrat; Castells, Xavier

doi:10.1148/radiol.2521080696

Cited by 48 publications

(24 citation statements)

References 20 publications

(28 reference statements)

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“…29,81,82 Breast density is therefore also explanatory of the greater risk for FP results in pre-menopausal females than in post-menopausal females. 36,83 Inherent limitations of conventional mammography Poor discrimination between malignant and benign pathologies can be linked to limitations inherent to the method by which a mammogram is acquired. The two-dimensional (2D) projection of an X-ray beam through a three-dimensional volume of soft tissue results in the unavoidable superimposition of various structures upon an intricate network of the glandular tissue.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

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The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.

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Section: Patient Characteristicsmentioning

confidence: 99%

Is the false-positive rate in mammography in North America too high?

Le¹,

Mothersill²,

Seymour³

et al. 2016

BJR

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“…Authors of previous populationbased studies comparing the accuracy of SFM and FFDM have shown conflicting results, particularly with respect to age-specific performance (4)(5)(6)(7). The reported recall rates for FFDM compared with those for SFM have varied widely (3,5).…”

Section: Breast Imaging: Transition From Screen-film To Full-field DImentioning

confidence: 99%

Mammographic Performance in a Population-based Screening Program: Before, during, and after the Transition from Screen-Film to Full-Field Digital Mammography

Hofvind¹,

Skaane²,

Elmore³

et al. 2014

Radiology

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MSHS Purpose:To compare performance measures before, during, and after the transition from screen-film mammography (SFM) to full-field digital mammography (FFDM) in a populationbased screening program. Materials and Methods:No institutional review board approval was required for this analysis involving anonymized data for women aged 50-69 years enrolled in the Norwegian Breast Cancer Screening Program during 1996-2010. The x 2 test was used to examine the equality of proportions of recall rates, positive predictive value of recall examinations and of invasive procedures, in addition to rates of screening-detected and interval cancers in women initially screened with SFM and FFDM and for women subsequently screened with SFM after SFM, FFDM after SFM, and FFDM after FFDM. Results:The recall rate was 3.4% (47 091 of 1 391 188) for SFM and 2.9% (13 130 of 446 172) for FFDM (P , .001). The biopsy rate was 1.4% (19 776 of 1 391 188) for SFM and 1.1% (5108 of 446 172) for FFDM (P , .001). The rate of screeningdetected ductal carcinoma in situ was higher (P = .019) while the rate of invasive breast cancer was lower (P , .001) for FFDM compared with those for SFM. The rate of both invasive screening-detected and interval breast cancer remained stable during the transition from SFM to FFDM (when the previous examination was SFM) and after FFDM was firmly established (when the previous examination was FFDM, .25 months after FFDM adoption) (P , .05). The positive predictive value of recall examinations and of invasive procedures increased from 19.3% (4559 of 23 598) and 48.3% (4651 of 9623) to 22.7% (681 of 2995) and 57.5% (689 of 1198), respectively, after adoption of FFDM (P , .001). Conclusion:After the initial transitional phase from SFM to FFDM, population-based screening with FFDM is associated with less harm because of lower recall and biopsy rates and higher positive predictive values after biopsy than screening with SFM.q RSNA, 2014

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“…M ammography is the current standard for breast cancer screening because of its impressive advantages for detection performance, imaging time, and cost-effectiveness (1)(2)(3)(4)(5). However, radiologists also widely recognize its limitations, especially for dense breasts (6)(7)(8).…”

Section: Methodsmentioning

confidence: 99%

Breast Tissue Characterization with Photon-counting Spectral CT Imaging: A Postmortem Breast Study

Ding¹,

Klopfer²,

Ducote³

et al. 2014

Radiology

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Purpose:To investigate the feasibility of breast tissue characterization in terms of water, lipid, and protein contents with a spectral computed tomographic (CT) system based on a cadmium zinc telluride (CZT) photon-counting detector by using postmortem breasts. Materials and Methods:Nineteen pairs of postmortem breasts were imaged with a CZT-based photon-counting spectral CT system with beam energy of 100 kVp. The mean glandular dose was estimated to be in the range of 1.8-2.2 mGy. The images were corrected for pulse pile-up and other artifacts by using spectral distortion corrections. Dual-energy decomposition was then applied to characterize each breast into water, lipid, and protein contents. The precision of the three-compartment characterization was evaluated by comparing the composition of right and left breasts, where the standard error of the estimations was determined. The results of dual-energy decomposition were compared by using averaged root mean square to chemical analysis, which was used as the reference standard.

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Implementation of Digital Mammography in a Population-based Breast Cancer Screening Program: Effect of Screening Round on Recall Rate and Cancer Detection

Abstract: Digital mammography may reduce the adverse effects of screening programs if this technique is confirmed to have the same diagnostic accuracy as screen-film mammography.

Cited by 48 publications

References 20 publications

Is the false-positive rate in mammography in North America too high?

Is the false-positive rate in mammography in North America too high?

Mammographic Performance in a Population-based Screening Program: Before, during, and after the Transition from Screen-Film to Full-Field Digital Mammography

Breast Tissue Characterization with Photon-counting Spectral CT Imaging: A Postmortem Breast Study

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