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Am J Prev Med. 2015 May;48(5):535-42. doi: 10.1016/j.amepre.2014.11.010.

Transition from film to digital mammography: impact for breast cancer screening through the national breast and cervical cancer early detection program.

Author information

Department of Public Health, Erasmus MC, University Medical Center, Rotterdam. Electronic address:
Department of Public Health, Erasmus MC, University Medical Center, Rotterdam; Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands.
Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein School of Medicine, Bronx, New York.
CDC, Atlanta, Georgia.
Department of Oncology, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, District of Columbia.
Statistical Research and Application Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland.
Department of Public Health, Erasmus MC, University Medical Center, Rotterdam.



The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides mammograms and diagnostic services for low-income, uninsured women aged 40-64 years. Mammography facilities within the NBCCEDP gradually shifted from plain-film to digital mammography. The purpose of this study is to assess the impact of replacing film with digital mammography on health effects (deaths averted, life-years gained [LYG]); costs (for screening and diagnostics); and number of women reached.


NBCCEDP 2010 data and data representative of the program's target population were used in two established microsimulation models. Models simulated observed screening behavior including different screening intervals (annual, biennial, irregular) and starting ages (40, 50 years) for white, black, and Hispanic women. Model runs were performed in 2012.


The models predicted 8.0-8.3 LYG per 1,000 film screens for black women, 5.9-7.5 for white women, and 4.0-4.5 for Hispanic women. For all race/ethnicity groups, digital mammography had more LYG than film mammography (2%-4%), but had higher costs (34%-35%). Assuming a fixed budget, 25%-26% fewer women could be served, resulting in 22%-24% fewer LYG if all mammograms were converted to digital. The loss in LYG could be reversed to an 8%-13% increase by only including biennial screening.


Digital could result in slightly more LYG than film mammography. However, with a fixed budget, fewer women may be served with fewer LYG. Changes in the program, such as only including biennial screening, will increase LYG/screen and could offset the potential decrease in LYG when shifting to digital mammography.

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