Joost Nederend1, Lucien E M Duijm2, Marieke W J Louwman3, Jan Willem Coebergh3, Rudi M H Roumen4, Paul N Lohle5, Jan A Roukema6, Matthieu J C M Rutten7, Liza N van Steenbergen3, Miranda F Ernst8, Frits H Jansen9, Menno L Plaisier10, Marianne J H H Hooijen11, Adri C Voogd12. 1. Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands. Electronic address: joost.nederend@cze.nl. 2. Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands. 3. Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands. 4. Department of Surgery, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands. 5. Department of Radiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands. 6. Department of Surgery, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands. 7. Department of Radiology, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands. 8. Department of Surgery, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands. 9. Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands. 10. Department of Radiology, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands. 11. Department of Radiology, St. Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The Netherlands. 12. Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229 HA Maastricht, The Netherlands.
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INTRODUCTION: In most breast screening programmes screen-film mammography (SFM) has been replaced by full-field digital mammography (FFDM).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.
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.
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