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Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates.

Bluekens AM, Karssemeijer N, Beijerinck D, Deurenberg JJ, van Engen RE, Broeders MJ, den Heeten GJ - Eur Radiol (2010)

Bottom Line: 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.Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.

View Article: PubMed Central - PubMed

Affiliation: National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands. a.bluekens@lrcb.umcn.nl

ABSTRACT

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.

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Related in: MedlinePlus

Time course of referral in a FFDM and b SFM screening for first (○) and subsequent (♦) screening examinations
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Fig1: Time course of referral in a FFDM and b SFM screening for first (○) and subsequent (♦) screening examinations

Mentions: In Fig. 1 the referral rates for first and subsequent screening examinations with FFDM and SFM respectively are presented separately. The implementation of FFDM induced an increase in referral in first screens (73‰). With the introduction of subsequent screens in July 2004 another peak in referral was noted. This second peak in referral (37‰) was significantly higher (p < 0.001) compared with its future baseline and relatively much higher than the decreasing, though still elevated, referral rate in first screens during that same period.Fig. 1


Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates.

Bluekens AM, Karssemeijer N, Beijerinck D, Deurenberg JJ, van Engen RE, Broeders MJ, den Heeten GJ - Eur Radiol (2010)

Time course of referral in a FFDM and b SFM screening for first (○) and subsequent (♦) screening examinations
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2914257&req=5

Fig1: Time course of referral in a FFDM and b SFM screening for first (○) and subsequent (♦) screening examinations
Mentions: In Fig. 1 the referral rates for first and subsequent screening examinations with FFDM and SFM respectively are presented separately. The implementation of FFDM induced an increase in referral in first screens (73‰). With the introduction of subsequent screens in July 2004 another peak in referral was noted. This second peak in referral (37‰) was significantly higher (p < 0.001) compared with its future baseline and relatively much higher than the decreasing, though still elevated, referral rate in first screens during that same period.Fig. 1

Bottom Line: 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.Referral rates decrease and stabilise (learning curve effect) at a higher level than in conventional screening, yet with significantly enhanced cancer detection.

View Article: PubMed Central - PubMed

Affiliation: National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ, Nijmegen, The Netherlands. a.bluekens@lrcb.umcn.nl

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus