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Comparison of Digital Mammography and Screen-Film Mammography in Breast Cancer Screening: A Review in the Irish Breast Screening Program

¹ Department of Radiology, Irish National Breast Screening Programme, Eccles Screening Unit, Dublin, Ireland.
² Present address: Jefferson-Honickman Breast Imaging, Thomas Jefferson University Hospital, 1100 Walnut St., Philadelphia, PA 19107.
³ Department of Medical Physics, Irish National Breast Screening Programme, Eccles Screening Unit, Dublin, Ireland.
⁴ Department of Radiology, Irish National Breast Screening Programme, Merrion Screening Unit, Dublin, Ireland.

OBJECTIVE. Clinical trials to date into the use of full-field digital mammography (FFDM) for breast cancer screening have shown variable results. The aim of this study was to review the use of FFDM in a population-based breast cancer screening program and to compare the results with screen-film mammography.

MATERIALS AND METHODS. The study included 188,823 screening examinations of women between 50 and 64 years old; 35,204 (18.6%) mammograms were obtained using FFDM. All films were double read using a 5-point rating scale to indicate the probability of cancer. Patients with positive scores were recalled for further workup. The recall rate, cancer detection rate, and positive predictive value (PPV) of FFDM were compared with screen-film mammography.

RESULTS. The cancer detection rate was significantly higher for FFDM than screen-film mammography (6.3 vs 5.2 per 1,000, respectively; p = 0.01). The cancer detection rate for FFDM was higher than screen-film mammography for initial screening and subsequent screening, for invasive cancer and ductal carcinoma in situ, and across all age groups. The cancer detection rate for cancers presenting as microcalcifications was significantly higher for FFDM than for screen-film mammography (1.9 vs 1.3 per 1,000, p = 0.01). The recall rate was significantly higher for FFDM than screen-film mammography (4.0% vs 3.1%, p < 0.001). There was no significant difference in the PPVs of recall to assessment for FFDM and screen-film mammography (15.7% and 16.7%, p = 0.383).

CONCLUSION. FFDM resulted in significantly higher cancer detection and recall rates than screen-film mammography in women 50–64 years old. The PPVs of FFDM and screen-film mammography were comparable. The results of this study suggest that FFDM can be safely implemented in breast cancer screening programs.

Keywords: breast cancer • breast cancer screening • breast imaging • digital imaging • digital mammography • screen-film mammography

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