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Published on: August 30, 2013
Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact
Adriana M J Bluekens1, Nico Karssemeijer, David Beijerinck
1National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands. a.bluekens@lrcb.umcn.nl
Objectives:
To investigate the referral pattern after the transition to full-field digital mammography (FFDM) in a population-based breast cancer screening programme.
Methods:
Preceding the nationwide digitalisation of the Dutch screening programme, an FFDM feasibility study was conducted. Detection and referral rates for FFDM and screen-film mammography (SFM) were compared for first and subsequent screens. Furthermore, radiological characteristics of referrals in digital screening were assessed.
Results:
A total of 312,414 screening mammograms were performed (43,913 digital and 268,501 conventional), with 4,473 consecutive referrals (966 following FFDM). Initially the FFDM referral rate peaked, and many false-positive results were noted as a consequence of pseudolesions and increased detection of (benign) microcalcifications. A higher overall referral rate was observed in FFDM screening in both first and subsequent examinations (p < .001), with a significant increase in cancer detection (p = .010).
Conclusion:
As a result of initial inexperience with digital screening images implementing FFDM in a population-based breast cancer screening programme may lead to a strong, but temporary increase in referral. Dedicated training in digital screening for radiographers and screening radiologists is therefore recommended. Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.
