Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 5;18(1):256.
doi: 10.1186/s12885-018-4122-2.

Detection and interval cancer rates during the transition from screen-film to digital mammography in population-based screening

Valérie D V Sankatsing  1 , Jacques Fracheboud  2 , Linda de Munck  3 , Mireille J M Broeders  4   5 , Nicolien T van Ravesteyn  2 , Eveline A M Heijnsdijk  2 , André L M Verbeek  4 , Johannes D M Otten  4 , Ruud M Pijnappel  5   6 , Sabine Siesling  3   7 , Harry J de Koning  2 ; National Evaluation Team for Breast cancer screening, NETB
Affiliations

Detection and interval cancer rates during the transition from screen-film to digital mammography in population-based screening

Valérie D V Sankatsing et al. BMC Cancer. .

Abstract

Background: Between 2003 and 2010 digital mammography (DM) gradually replaced screen-film mammography (SFM) in the Dutch breast cancer screening programme (BCSP). Previous studies showed increases in detection rate (DR) after the transition to DM. However, national interval cancer rates (ICR) have not yet been reported.

Methods: We assessed programme sensitivity and specificity during the transition period to DM, analysing nationwide data on screen-detected and interval cancers. Data of 7.3 million screens in women aged 49-74, between 2004 and 2011, were linked to the Netherlands Cancer Registry to obtain data on interval cancers. Age-adjusted DRs, ICRs and recall rates (RR) per 1000 screens and programme sensitivity and specificity were calculated by year, age and screening modality.

Results: 41,662 screen-detected and 16,160 interval cancers were analysed. The DR significantly increased from 5.13 (95% confidence interval (CI):5.00-5.30) in 2004 to 6.34 (95% CI:6.15-6.47) in 2011, for both in situ (2004:0.73;2011:1.24) and invasive cancers (2004:4.42;2011:5.07), whereas the ICR remained stable (2004: 2.16 (95% CI2.06-2.25);2011: 2.13 (95% CI:2.04-2.22)). The RR changed significantly from 14.0 to 21.4. Programme sensitivity significantly increased, mainly between ages 49-59, from 70.0% (95% CI:68.9-71.2) to 74.4% (95% CI:73.5-75.4) whereas specificity slightly declined (2004:99.1% (95% CI:99.09-99.13);2011:98.5% (95% CI:98.45-98.50)). The overall DR was significantly higher for DM than for SFM (6.24;5.36) as was programme sensitivity (73.6%;70.1%), the ICR was similar (2.19;2.20) and specificity was significantly lower for DM (98.5%;98.9%).

Conclusions: During the transition from SFM to DM, there was a significant rise in DR and a stable ICR, leading to increased programme sensitivity. Although the recall rate increased, programme specificity remained high compared to other countries. These findings indicate that the performance of DM in a nationwide screening programme is not inferior to, and may be even better, than that of SFM.

Keywords: Breast cancer screening; Detection rate; Digital mammography; Interval cancers; Programme sensitivity; Programme specificity; Screen-film mammography.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The Dutch population screening program was approved by the Ministry of Health and the Population screening act.1 According to the Central Committee on Research involving Human Subjects (CCMO)2, this study did not require approval from an ethics committee in the Netherlands. For this study, only aggregated data, and thus no individual data, were used. Permission in the form of written consent to the Dutch screening program (operates under Population Screening Act) for the linkage to the Netherlands Cancer Registry (NCR) is requested when women attend screening. Linkage was only possible if permission was received. No individual data were made available in this study.

1 http://wetten.overheid.nl/BWBR0005699/2014-02-15

2 http://www.ccmo.nl/

Consent for publication

Not applicable.

Competing interests

Dr. E.A.M. Heijnsdijk and Prof. Dr. H.J. de Koning report receiving a research grant from SCOR. Mireille Broeders is a member of the editorial board (Associate Editor) of this journal (BMC Cancer).

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Age-adjusted detection and interval cancer rates per 1000 women screened for all screens (a) and DM or SFMa (b) (49–74). aIn 2011 all screens were DM screens. Abbreviations: detection rate (DR); interval cancer rate (ICR); digital mammography (DM); screen-film mammography (SFM)
Fig. 2
Fig. 2
Age-specific detection (a) and interval cancer rates (b) per 1000 women screened
Fig. 3
Fig. 3
Age adjusted-interval cancer rate (per 1000 women screened) for all, invasive and in situ carcinomas
Fig. 4
Fig. 4
Aged-adjusted programme sensitivity (a) and programme specificity (b) for all screens, DMa and SFM (49–74). aThe percentage DM screens between 2004 and 2007 was considerably small; in 2011, all screens were DM screens. N.B. scale Y-axis differs between graph a and b. Abbreviations: digital mammography (DM); screen-film mammography (SFM)
Fig. 5
Fig. 5
Age-adjusted programme sensitivity for all (invasive + DCIS) and invasive breast cancers only (49–74)
See this image and copyright information in PMC

References

    1. Fracheboud J, de Koning HJ, Beemsterboer PM, Boer R, Verbeek AL, Hendriks JH, van Ineveld BM, Broeders MJ, de Bruyn AE, van der Maas PJ. Interval cancers in the Dutch breast cancer screening programme. Br J Cancer. 1999;81(5):912–917. doi: 10.1038/sj.bjc.6690786. - DOI - PMC - PubMed
    1. Hofvind S, Yankaskas BC, Bulliard JL, Klabunde CN, Fracheboud J. Comparing interval breast cancer rates in Norway and North Carolina: results and challenges. J Med Screen. 2009;16(3):131–139. doi: 10.1258/jms.2009.009012. - DOI - PubMed
    1. Bennett RL, Sellars SJ, Moss SM. Interval cancers in the NHS breast cancer screening programme in England, Wales and Northern Ireland. Br J Cancer. 2011;104(4):571–577. doi: 10.1038/bjc.2011.3. - DOI - PMC - PubMed
    1. Dibden A, Offman J, Parmar D, Jenkins J, Slater J, Binysh K, McSorley J, Scorfield S, Cumming P, Liao XH, et al. Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme. Br J Cancer. 2014;110(3):560–564. doi: 10.1038/bjc.2013.778. - DOI - PMC - PubMed
    1. Del Turco MR, Mantellini P, Ciatto S, Bonardi R, Martinelli F, Lazzari B, Houssami N. Full-field digital versus screen-film mammography: comparative accuracy in concurrent screening cohorts. AJR Am J Roentgenol. 2007;189(4):860–866. doi: 10.2214/AJR.07.2303. - DOI - PubMed

Publication types