Digital mammography screening: Weighing reduced mortality against increased overdiagnosis
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.
|Keywords||Breast neoplasms, Carcinoma, Computer Simulation, Early diagnosis, Intraductal, Mammography, Mass screening, Mortality, Noninfiltrating, Risk assessment|
|Persistent URL||dx.doi.org/10.1016/j.ypmed.2011.06.009, hdl.handle.net/1765/33305|
de Gelder, R, Fracheboud, J, Heijnsdijk, E.A.M, den Heeten, G, Verbeek, A.L.M, Broeders, M.J.M, … de Koning, H.J. (2011). Digital mammography screening: Weighing reduced mortality against increased overdiagnosis. Preventive Medicine, 53(3), 134–140. doi:10.1016/j.ypmed.2011.06.009