Digital Mammography in European Population-Based Screening Programs

Abstract

Full-field digital mammography (FFDM) offers several benefits when compared with screen-film mammography (SFM) in breast cancer screening, such as: Elimination of technical failure recalls; simplified archival, retrieval, and transmission of images; reduction of average glandular dose; higher patient work-flow; improved diagnostic accuracy, especially in women with dense breast parenchyma due to higher contrast resolution; implementation of advanced technologies including computer-aided detection (CAD) and tomosynthesis; and the potential for telemammography and teleconsultation. Several European studies comparing FFDM and SFM in population-based breast cancer screening programs have demonstrated a higher cancer detection rate at FFDM approaching borderline significance in some studies, and showing statistically significant higher detection rate in women presenting with Ductal carcinoma in-situ (DCIS) or clustered microcalcifications. The higher cancer detection rate is, however, achieved at the cost of a higher recall rate. Overall, there has been no significant difference in the positive predictive value between FFDM and SFM. The huge challenge of interobserver variability for interpretation in mammography screening may have prevented the advantages from being observed in several studies, and will also, in the future, be a challenge for trials comparing the two imaging techniques.