Digital mammography screening: weighing reduced mortality against increased overdiagnosis |
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Authors: | de Gelder Rianne Fracheboud Jacques Heijnsdijk Eveline A M den Heeten Gerard Verbeek André L M Broeders Mireille J M Draisma Gerrit de Koning Harry J |
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Institution: | a Erasmus MC, Department of Public Health, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlandsb National Expert and Training Centre for Breast Cancer Screening, Radboud University Nijmegen Medical Centre, PO Box 6873, 6503 GJ Nijmegen, The Netherlandsc Radboud University Nijmegen Medical Centre, Department of Epidemiology, Biostatistics and HTA, PO Box 9101, 6500 HB Nijmegen, The Netherlands |
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Abstract: | ObjectiveDigital mammography has been shown to increase the detection of ductal carcinoma in situ (DCIS) compared to screen-film mammography. The benefits and risks of such an increase were assessed.MethodsBreast cancer detection rates were compared between 502,574 screen-film and 83,976 digital mammograms performed between 2004 and 2006 among Dutch screening participants. The detection rates were then modeled using a baseline model and two extreme models that respectively assumed a high rate of progression and no progression of preclinical DCIS to invasive cancer. With these models, breast cancer mortality and overdiagnosis were predicted.ResultsThe DCIS detection rate was significantly higher at digital mammography (1.2 per 1000 mammograms (95% C.I. 1.0-1.5)) than at screen-film mammography (0.7 per 1000 mammograms (95% C.I. 0.6-0.7)). Consequently, 287 (range progressive- non progressive model: 1-598) extra breast cancer deaths per 1,000,000 women (a 4.4% increase) were predicted to be prevented. An extra 401 (range: 165-2271) cancers would be overdiagnosed (a 21% increase).ConclusionModeling predicted that digital mammography screening would further reduce breast cancer mortality by 4.4%, at a 21% increased overdiagnosis rate. The consequences of digital screening, however, are sensitive to underlying assumptions on the natural history of DCIS. |
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Keywords: | Breast neoplasms Mass screening Early diagnosis Mammography Carcinoma Intraductal Noninfiltrating Computer Simulation Risk assessment Mortality |
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