OBJECTIVE: Digital mammography has been shown to increase the detection of ductal carcinoma in situ (DCIS) compared to screen-film mammography. The benefits and risks of such an increase were assessed. METHODS: Breast cancer detection rates were compared between 502,574 screen-film and 83,976 digital mammograms performed between 2004 and 2006 among Dutch screening participants. The detection rates were then modeled using a baseline model and two extreme models that respectively assumed a high rate of progression and no progression of preclinical DCIS to invasive cancer. With these models, breast cancer mortality and overdiagnosis were predicted. RESULTS: The DCIS detection rate was significantly higher at digital mammography (1.2 per 1000 mammograms (95% C.I. 1.0-1.5)) than at screen-film mammography (0.7 per 1000 mammograms (95% C.I. 0.6-0.7)). Consequently, 287 (range progressive- non progressive model: 1-598) extra breast cancer deaths per 1,000,000 women (a 4.4% increase) were predicted to be prevented. An extra 401 (range: 165-2271) cancers would be overdiagnosed (a 21% increase). CONCLUSION: Modeling predicted that digital mammography screening would further reduce breast cancer mortality by 4.4%, at a 21% increased overdiagnosis rate. The consequences of digital screening, however, are sensitive to underlying assumptions on the natural history of DCIS.
OBJECTIVE: Digital mammography has been shown to increase the detection of ductal carcinoma in situ (DCIS) compared to screen-film mammography. The benefits and risks of such an increase were assessed. METHODS:Breast cancer detection rates were compared between 502,574 screen-film and 83,976 digital mammograms performed between 2004 and 2006 among Dutch screening participants. The detection rates were then modeled using a baseline model and two extreme models that respectively assumed a high rate of progression and no progression of preclinical DCIS to invasive cancer. With these models, breast cancer mortality and overdiagnosis were predicted. RESULTS: The DCIS detection rate was significantly higher at digital mammography (1.2 per 1000 mammograms (95% C.I. 1.0-1.5)) than at screen-film mammography (0.7 per 1000 mammograms (95% C.I. 0.6-0.7)). Consequently, 287 (range progressive- non progressive model: 1-598) extra breast cancer deaths per 1,000,000women (a 4.4% increase) were predicted to be prevented. An extra 401 (range: 165-2271) cancers would be overdiagnosed (a 21% increase). CONCLUSION: Modeling predicted that digital mammography screening would further reduce breast cancer mortality by 4.4%, at a 21% increased overdiagnosis rate. The consequences of digital screening, however, are sensitive to underlying assumptions on the natural history of DCIS.
Authors: Tanya D Geertse; Roland Holland; Janine M H Timmers; Ellen Paap; Ruud M Pijnappel; Mireille J M Broeders; Gerard J den Heeten Journal: Eur Radiol Date: 2015-04-23 Impact factor: 5.315
Authors: Nicolien T van Ravesteyn; Natasha K Stout; Clyde B Schechter; Eveline A M Heijnsdijk; Oguzhan Alagoz; Amy Trentham-Dietz; Jeanne S Mandelblatt; Harry J de Koning Journal: J Natl Cancer Inst Date: 2015-05-06 Impact factor: 13.506
Authors: Marc D Ryser; Jane Lange; Lurdes Y T Inoue; Ellen S O'Meara; Charlotte Gard; Diana L Miglioretti; Jean-Luc Bulliard; Andrew F Brouwer; E Shelley Hwang; Ruth B Etzioni Journal: Ann Intern Med Date: 2022-03-01 Impact factor: 51.598
Authors: Jeroen J van den Broek; Nicolien T van Ravesteyn; Eveline A Heijnsdijk; Harry J de Koning Journal: Med Decis Making Date: 2018-04 Impact factor: 2.583