Lore Timmermans1, Luc Bleyen2, Klaus Bacher3, Koen Van Herck2, Kim Lemmens4, Chantal Van Ongeval4, Andre Van Steen4, Patrick Martens5, Isabel De Brabander6, Mathieu Goossens7, Hubert Thierens3. 1. Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium. Lore.Timmermans@UGent.be. 2. Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium. 3. Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium. 4. Department of Radiology, University Hospitals Leuven, Leuven, Belgium. 5. Centrum voor Kankeropsporing, Bruges, Belgium. 6. Belgian Cancer Registry, Brussels, Belgium. 7. Dienst Kankerpreventie, UZ Brussel, Brussels, Belgium.
Abstract
OBJECTIVES: To investigate if direct radiography (DR) performs better than screen-film mammography (SF) and computed radiography (CR) in dense breasts in a decentralized organised Breast Cancer Screening Programme. To this end, screen-detected versus interval cancers were studied in different BI-RADS density classes for these imaging modalities. METHODS: The study cohort consisted of 351,532 women who participated in the Flemish Breast Cancer Screening Programme in 2009 and 2010. Information on screen-detected and interval cancers, breast density scores of radiologist second readers, and imaging modality was obtained by linkage of the databases of the Centre of Cancer Detection and the Belgian Cancer Registry. RESULTS: Overall, 67% of occurring breast cancers are screen detected and 33% are interval cancers, with DR performing better than SF and CR. The interval cancer rate increases gradually with breast density, regardless of modality. In the high-density class, the interval cancer rate exceeds the cancer detection rate for SF and CR, but not for DR. CONCLUSIONS: DR is superior to SF and CR with respect to cancer detection rates for high-density breasts. To reduce the high interval cancer rate in dense breasts, use of an additional imaging technique in screening can be taken into consideration. KEY POINTS: • Interval cancer rate increases gradually with breast density, regardless of modality. • Cancer detection rate in high-density breasts is superior in DR. • IC rate exceeds CDR for SF and CR in high-density breasts. • DR performs better in high-density breasts for third readings and false-positives.
OBJECTIVES: To investigate if direct radiography (DR) performs better than screen-film mammography (SF) and computed radiography (CR) in dense breasts in a decentralized organised Breast Cancer Screening Programme. To this end, screen-detected versus interval cancers were studied in different BI-RADS density classes for these imaging modalities. METHODS: The study cohort consisted of 351,532 women who participated in the Flemish Breast Cancer Screening Programme in 2009 and 2010. Information on screen-detected and interval cancers, breast density scores of radiologist second readers, and imaging modality was obtained by linkage of the databases of the Centre of Cancer Detection and the Belgian Cancer Registry. RESULTS: Overall, 67% of occurring breast cancers are screen detected and 33% are interval cancers, with DR performing better than SF and CR. The interval cancer rate increases gradually with breast density, regardless of modality. In the high-density class, the interval cancer rate exceeds the cancer detection rate for SF and CR, but not for DR. CONCLUSIONS: DR is superior to SF and CR with respect to cancer detection rates for high-density breasts. To reduce the high interval cancer rate in dense breasts, use of an additional imaging technique in screening can be taken into consideration. KEY POINTS: • Interval cancer rate increases gradually with breast density, regardless of modality. • Cancer detection rate in high-density breasts is superior in DR. • IC rate exceeds CDR for SF and CR in high-density breasts. • DR performs better in high-density breasts for third readings and false-positives.
Entities:
Keywords:
Breast cancer screening; Breast density; Digital mammography; Interval cancers; Screen-film mammography
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