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AJR Am J Roentgenol. 2015 Sep;205(3):676-84. doi: 10.2214/AJR.14.13904.

Breast Cancer Characteristics Associated With Digital Versus Film-Screen Mammography for Screen-Detected and Interval Cancers.

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1 Department of Radiology, The University of North Carolina at Chapel Hill, 130 Mason Farm Rd, 3124 Bioinformatics Building, CB 7515, Chapel Hill, NC 27599.
2 Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, CA.
3 Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA.
4 Group Health Research Institute, Seattle, WA.
5 Department of Surgery, University of Vermont, Burlington, VT.
6 Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA.



The purpose of this study was to determine whether pathologic findings of screen-detected and interval cancers differ for digital versus film mammography.


Breast Cancer Surveillance Consortium data from 2003-2011 on 3,021,515 screening mammograms (40.3% digital, 59.7% film) of women 40-89 years old were reviewed. Cancers were considered screen detected if diagnosed within 12 months of an examination with positive findings and interval if diagnosed within 12 months of an examination with negative findings. Tumor characteristics for screen-detected and interval cancers were compared for digital versus film mammography by use of logistic regression models to estimate the odds ratio and 95% CI with adjustment for age, race and ethnicity, hormone therapy use, screening interval, examination year, and registry. Generalized estimating equations were used to account for correlation within facilities.


Among 15,729 breast cancers, 85.3% were screen detected and 14.7% were interval. Digital and film mammography had similar rates of screen-detected (4.47 vs 4.42 per 1000 examinations) and interval (0.73 vs 0.79 per 1000 examinations) cancers for digital versus film. In adjusted analyses, interval cancers diagnosed after digital examinations with negative findings were less likely to be American Joint Committee on Cancer stage IIB or higher (odds ratio, 0.69; 95% CI, 0.52-0.93), have positive nodal status (odds ratio, 0.78; 95% CI, 0.64-0.95), or be estrogen receptor negative (odds ratio, 0.71; 95% CI, 0.56-0.91) than were interval cancers diagnosed after a film examination with negative findings.


Screen-detected cancers diagnosed after digital and film mammography had similar rates of unfavorable tumor characteristics. Interval-detected cancers diagnosed after a digital examination were less likely to have unfavorable tumor features than those diagnosed after film mammography, but the absolute differences were small.


digital mammography; film mammography; interval cancer; screen-detected cancer

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