Abstract
BackgroundTo determine the proportion of “true” interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM).MethodsWe included all women with interval cancers detected between January 2006 and January 2014. Breast imaging reports, biopsy results and breast surgery reports of all women recalled at screening mammography and of all women with interval breast cancers were collected. Two experienced screening radiologists reviewed the diagnostic mammograms, on which the interval cancers were diagnosed, as well as the prior screening mammograms and determined whether or not the interval cancer had been missed on the most recent screening mammogram. If not missed, the cancer was considered an occult (“true”) interval cancer.ResultsA total of 442 interval cancers had been diagnosed, of which 144 at SFM with a prior SFM (SFM-SFM), 159 at FFDM with a prior SFM (FFDM-SFM) and 139 at FFDM with a prior FFDM (FFDM-FFDM). The transition from SFM to FFDM screening resulted in the diagnosis of more occult (“true”) interval cancers at FFDM-SFM than at SFM-SFM (65.4% (104/159) versus 49.3% (71/144), P < 0.01), but this increase was no longer statistically significant in women who had been screened digitally for the second time (57.6% (80/139) at FFDM-FFDM versus 49.3% (71/144) at SFM-SFM). Tumor characteristics were comparable for the three interval cancer cohorts, except of a lower porportion (75.7 and 78.0% versus 67.2% af FFDM-FFDM, P < 0.05) of invasive ductal cancers at FFDM with prior FFDM.ConclusionsAn increase in the proportion of occult interval cancers is observed during the transition from SFM to FFDM screening mammography. However, this increase seems temporary and is no longer detectable after the second round of digital screening. Tumor characteristics and type of surgery are comparable for interval cancers detected prior to, during and after the transition from SFM to FFDM screening mammography, except of a lower proportion of invasive ductal cancers after the transition.
Highlights
To determine the proportion of “true” interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM)
The transition from screen-film to digital screening mammography may increase the proportion of ductal carcinoma in-situ (DCIS) and smaller invasive cancers at the first digital screening round [3, 4, 11], but does not appear to result in a change of the tumor characteristics of the interval cancers [4, 5]
Prior visibility and mammographic characteristics of interval cancers A significantly larger proportion of interval cancers at subsequent screening mammography was considered occult at the first digital screening round than at screen-film screening (65.4% at FFDM-SFM versus 49.3% at SFM with a prior SFM (SFM-SFM), P < 0.01, Table 1)
Summary
To determine the proportion of “true” interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM). The transition from screen-film to digital screening mammography may increase the proportion of ductal carcinoma in-situ (DCIS) and smaller invasive cancers at the first digital screening round [3, 4, 11], but does not appear to result in a change of the tumor characteristics of the interval cancers [4, 5]. The proportion of missed interval cancers among all interval cancers, and of interval cancers showing minimal signs at the most recent screening mammogram, were lower at digital than at screen-film screening It is not known whether or not this effect remains present after the transition to FFDM (i.e., in women who undergo a second digital screening examination). In the current study we determined interval cancer characteristics, tumor stage and surgical procedure prior to, during and after the transition from SFM to FFDM screening mammography
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