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Prev Med. 2011 Sep;53(3):134-40. doi: 10.1016/j.ypmed.2011.06.009. Epub 2011 Jun 21.

Digital mammography screening: weighing reduced mortality against increased overdiagnosis.

Author information

1
Erasmus MC, Department of Public Health, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. r.degelder@erasmusmc.nl

Abstract

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.

PMID:
21718717
DOI:
10.1016/j.ypmed.2011.06.009
[Indexed for MEDLINE]

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