Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening
Etta D. Pisano, M.D., Constantine Gatsonis, Ph.D., Edward Hendrick, Ph.D., Martin Yaffe, Ph.D., Janet K. Baum, M.D., Suddhasatta Acharyya, Ph.D., Emily F. Conant, M.D., Laurie L. Fajardo, M.D., Lawrence Bassett, M.D., Carl D'Orsi, M.D., Roberta Jong, M.D., Murray Rebner, M.D., for the Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group
Background Film mammography has limited sensitivity for thedetection of breast cancer in women with radiographically densebreasts. We assessed whether the use of digital mammographywould avoid some of these limitations.
Methods A total of 49,528 asymptomatic women presenting forscreening mammography at 33 sites in the United States and Canadaunderwent both digital and film mammography. All relevant informationwas available for 42,760 of these women (86.3 percent). Mammogramswere interpreted independently by two radiologists. Breast-cancerstatus was ascertained on the basis of a breast biopsy donewithin 15 months after study entry or a follow-up mammogramobtained at least 10 months after study entry. Receiver-operating-characteristic(ROC) analysis was used to evaluate the results.
Results In the entire population, the diagnostic accuracy ofdigital and film mammography was similar (difference betweenmethods in the area under the ROC curve, 0.03; 95 percent confidenceinterval, –0.02 to 0.08; P=0.18). However, the accuracyof digital mammography was significantly higher than that offilm mammography among women under the age of 50 years (differencein the area under the curve, 0.15; 95 percent confidence interval,0.05 to 0.25; P=0.002), women with heterogeneously dense orextremely dense breasts on mammography (difference, 0.11; 95percent confidence interval, 0.04 to 0.18; P=0.003), and premenopausalor perimenopausal women (difference, 0.15; 95 percent confidenceinterval, 0.05 to 0.24; P=0.002).
Conclusions The overall diagnostic accuracy of digital and filmmammography as a means of screening for breast cancer is similar,but digital mammography is more accurate in women under theage of 50 years, women with radiographically dense breasts,and premenopausal or perimenopausal women. (ClinicalTrials.govnumber, NCT00008346
[ClinicalTrials.gov]
.)
Source Information
From the Departments of Radiology and Biomedical Engineering, the Biomedical Research Imaging Center, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill (E.D.P.); the Center for Statistical Sciences, Brown University, Providence, R.I. (C.G., S.A.); the Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago (E.H.); the Departments of Medical Imaging (M.Y., R.J.) and Medical Biophysics (M.Y.), University of Toronto, Toronto; the Department of Radiology, Beth Israel Deaconess Medical Center, Boston (J.K.B.); the Department of Radiology, University of Pennsylvania Medical School, Philadelphia (E.F.C.); the Department of Radiology, University of Iowa, Iowa City (L.L.F.); the Department of Radiology, University of California at Los Angeles, Los Angeles (L.B.); the Department of Radiology, Emory University, Atlanta (C.D.); and the Department of Radiology, William Beaumont Hospital, Royal Oak, Mich. (M.R.). This article was published at www.nejm.org on September 16, 2005.
Address reprint requests to Dr. Pisano at etta_pisano{at}med.unc.edu.
GARNETT, S, WALLIS, M, MORGAN, G
(2009). Do screen-detected lobular and ductal carcinoma present with different mammographic features?. Br. J. Radiol.
82: 20-27
[Abstract][Full Text]
Haygood, T. M., Wang, J., Atkinson, E. N., Lane, D., Stephens, T. W., Patel, P., Whitman, G. J.
(2009). Timed Efficiency of Interpretation of Digital and Film-Screen Screening Mammograms. Am. J. Roentgenol.
192: 216-220
[Abstract][Full Text]
Hruska, C. B., Phillips, S. W., Whaley, D. H., Rhodes, D. J., O'Connor, M. K.
(2008). Molecular Breast Imaging: Use of a Dual-Head Dedicated Gamma Camera to Detect Small Breast Tumors. Am. J. Roentgenol.
191: 1805-1815
[Abstract][Full Text]
Heine, J. J., Carston, M. J., Scott, C. G., Brandt, K. R., Wu, F.-F., Pankratz, V. S., Sellers, T. A., Vachon, C. M.
(2008). An Automated Approach for Estimation of Breast Density. Cancer Epidemiol. Biomarkers Prev.
17: 3090-3097
[Abstract][Full Text]
Maillart, L. M., Ivy, J. S., Ransom, S., Diehl, K.
(2008). Assessing Dynamic Breast Cancer Screening Policies. Operations Research
56: 1411-1427
[Abstract]
Kavanagh, A. M., Byrnes, G. B., Nickson, C., Cawson, J. N., Giles, G. G., Hopper, J. L., Gertig, D. M., English, D. R.
(2008). Using Mammographic Density to Improve Breast Cancer Screening Outcomes. Cancer Epidemiol. Biomarkers Prev.
17: 2818-2824
[Abstract][Full Text]
Gur, D., Bandos, A. I., Cohen, C. S., Hakim, C. M., Hardesty, L. A., Ganott, M. A., Perrin, R. L., Poller, W. R., Shah, R., Sumkin, J. H., Wallace, L. P., Rockette, H. E.
(2008). The "Laboratory" Effect: Comparing Radiologists' Performance and Variability during Prospective Clinical and Laboratory Mammography Interpretations. Radiology
249: 47-53
[Abstract][Full Text]
Krug, K. B., Stutzer, H., Schroder, R., Boecker, J., Poggenborg, J., Lackner, K.
(2008). Image Quality of Digital Direct Flat-Panel Mammography Versus an Analog Screen-Film Technique Using a Low-Contrast Phantom. Am. J. Roentgenol.
191: W80-W88
[Abstract][Full Text]
Hofvind, S., Vacek, P. M., Skelly, J., Weaver, D. L., Geller, B. M.
(2008). Comparing Screening Mammography for Early Breast Cancer Detection in Vermont and Norway. JNCI J Natl Cancer Inst
100: 1082-1091
[Abstract][Full Text]
Hixson, G. L. Sr, Hendrick, R. E., Pisano, E. D., Yaffe, M. J., Gatsonis, C. A.
(2008). A Limitation of ACRIN DMIST. Radiology
248: 702-703
[Full Text]
Kopans, D. B., D. Pisano, E., Acharyya, S., Hendrick, R. E., Yaffe, M. J., Conant, E. F., Fajardo, L. L., Bassett, L. W., Baum, J. K., Gatsonis, C. A.
(2008). DMIST Results: Technologic or Observer Variability?. Radiology
248: 703-704
[Full Text]
Hillman, B. J., Gatsonis, C. A.
(2008). When Is the Right Time to Conduct a Clinical Trial of a Diagnostic Imaging Technology?. Radiology
248: 12-15
[Full Text]
Berg, W. A., Blume, J. D., Cormack, J. B., Mendelson, E. B., Lehrer, D., Bohm-Velez, M., Pisano, E. D., Jong, R. A., Evans, W. P., Morton, M. J., Mahoney, M. C., Hovanessian Larsen, L., Barr, R. G., Farria, D. M., Marques, H. S., Boparai, K., for the ACRIN 6666 Investigators,
(2008). Combined Screening With Ultrasound and Mammography vs Mammography Alone in Women at Elevated Risk of Breast Cancer. JAMA
299: 2151-2163
[Abstract][Full Text]
Kuhl, C. K.
(2008). The "Coming of Age" of Nonmammographic Screening for Breast Cancer. JAMA
299: 2203-2205
[Full Text]
MINIGH, J.
(2008). Quality Assurance in Digital Mammography. radtech
79: 433M-454M
[Abstract][Full Text]
Shannoun, F., Schanck, J.M., Scharpantgen, A., Wagnon, M.C., Ben Daoud, M., Back, C.
(2008). ORGANISATIONAL ASPECTS OF MAMMOGRAPHY SCREENING IN DIGITAL SETTINGS: FIRST EXPERIENCES OF LUXEMBOURG. Radiat Prot Dosimetry
0: ncn150v1-4
[Abstract][Full Text]
Gur, D.
(2008). Imaging Technology and Practice Assessment Studies: Importance of the Baseline or Reference Performance Level. Radiology
247: 8-11
[Full Text]
Hoogerbrugge, N., Kamm, Y. J. L., Bult, P., Landsbergen, K. M., Bongers, E. M. H. F., Brunner, H. G., Bonenkamp, H. J., de Hullu, J. A., Ligtenberg, M. J. L., Boetes, C.
(2008). The impact of a false-positive MRI on the choice for mastectomy in BRCA mutation carriers is limited. Ann Oncol
19: 655-659
[Abstract][Full Text]
Gur, D., Bandos, A. I., Rockette, H. E.
(2008). Comparing Areas under Receiver Operating Characteristic Curves: Potential Impact of the "Last" Experimentally Measured Operating Point. Radiology
247: 12-15
[Abstract][Full Text]
Bigenwald, R. Z., Warner, E., Gunasekara, A., Hill, K. A., Causer, P. A., Messner, S. J., Eisen, A., Plewes, D. B., Narod, S. A., Zhang, L., Yaffe, M. J.
(2008). Is Mammography Adequate for Screening Women with Inherited BRCA Mutations and Low Breast Density?. Cancer Epidemiol. Biomarkers Prev.
17: 706-711
[Abstract][Full Text]
Ravenel, J. G., Costello, P., Silvestri, G. A.
(2008). Screening for Lung Cancer. Am. J. Roentgenol.
190: 755-761
[Abstract][Full Text]
Lindfors, K. K., Boone, J. M., Nelson, T. R., Yang, K., Kwan, A. L. C., Miller, D. F.
(2008). Dedicated Breast CT: Initial Clinical Experience. Radiology
246: 725-733
[Abstract][Full Text]
Chlebowski, R. T., Anderson, G., Pettinger, M., Lane, D., Langer, R. D., Gillian, M. A., Walsh, B. W., Chen, C., McTiernan, A., for the Women's Health Initiative Investigators,
(2008). Estrogen Plus Progestin and Breast Cancer Detection by Means of Mammography and Breast Biopsy. Arch Intern Med
168: 370-377
[Abstract][Full Text]
Pisano, E. D., Hendrick, R. E., Yaffe, M. J., Baum, J. K., Acharyya, S., Cormack, J. B., Hanna, L. A., Conant, E. F., Fajardo, L. L., Bassett, L. W., D'Orsi, C. J., Jong, R. A., Rebner, M., Tosteson, A. N. A., Gatsonis, C. A.
(2008). Diagnostic Accuracy of Digital versus Film Mammography: Exploratory Analysis of Selected Population Subgroups in DMIST. Radiology
246: 376-383
[Abstract][Full Text]
Kopans, D. B., Jiang, Y., Miglioretti, D. L., Metz, C. E., Schmidt, R. A.
(2008). History Repeats. Radiology
246: 645-646
[Full Text]
Tosteson, A. N.A., Stout, N. K., Fryback, D. G., Acharyya, S., Herman, B. A., Hannah, L. G., Pisano, E. D., for the DMIST Investigators,
(2008). Cost-Effectiveness of Digital Mammography Breast Cancer Screening. ANN INTERN MED
148: 1-10
[Abstract][Full Text]
Gur, D.
(2007). Digital Mammography: Do We Need to Convert Now?. Radiology
245: 10-11
[Full Text]
Pisano, E. D., Hendrick, R. E., Yaffe, M., Conant, E. F., Gatsonis, C.
(2007). Should Breast Imaging Practices Convert to Digital Mammography? A Response from Members of the DMIST Executive Committee. Radiology
245: 12-13
[Full Text]
Maynard, C. D.
(2007). Eugene W. Caldwell Lecture 2007: Radiology Research Good to Great?. Am. J. Roentgenol.
189: 757-764
[Full Text]
Del Turco, M. R., Mantellini, P., Ciatto, S., Bonardi, R., Martinelli, F., Lazzari, B., Houssami, N.
(2007). Full-Field Digital Versus Screen-Film Mammography: Comparative Accuracy in Concurrent Screening Cohorts. Am. J. Roentgenol.
189: 860-866
[Abstract][Full Text]
Kuhl, C. K.
(2007). Current Status of Breast MR Imaging * Part 2. Clinical Applications. Radiology
244: 672-691
[Abstract][Full Text]
Skaane, P., Hofvind, S., Skjennald, A.
(2007). Randomized Trial of Screen-Film versus Full-Field Digital Mammography with Soft-Copy Reading in Population-based Screening Program: Follow-up and Final Results of Oslo II Study. Radiology
244: 708-717
[Abstract][Full Text]
Bevilacqua, J. L. B., Kattan, M. W., Fey, J. V., Cody, H. S. III, Borgen, P. I., Van Zee, K. J.
(2007). Doctor, What Are My Chances of Having a Positive Sentinel Node? A Validated Nomogram for Risk Estimation. JCO
25: 3670-3679
[Abstract][Full Text]
Pruthi, S., Brandt, K. R., Degnim, A. C., Goetz, M. P., Perez, E. A., Reynolds, C. A., Schomberg, P. J., Dy, G. K., Ingle, J. N.
(2007). A Multidisciplinary Approach to the Management of Breast Cancer, Part 1: Prevention and Diagnosis. Mayo Clin. Proc.
82: 999-1012
[Abstract][Full Text]
Robson, M., Offit, K.
(2007). Management of an Inherited Predisposition to Breast Cancer. NEJM
357: 154-162
[Full Text]
Ciatto, S., Houssami, N., Gur, D., Nishikawa, R. M., Schmidt, R. A., Metz, C. E., Ruiz, J. F., Feig, S. A., Birdwell, R. L., Linver, M. N., Fenton, J. J., Barlow, W. E., Elmore, J. G.
(2007). Computer-aided screening mammography.. NEJM
357: 83-84
[Full Text]
Yang, S. K., Moon, W. K., Cho, N., Park, J. S., Cha, J. H., Kim, S. M., Kim, S. J., Im, J.-G.
(2007). Screening Mammography-detected Cancers: Sensitivity of a Computer-aided Detection System Applied to Full-Field Digital Mammograms. Radiology
244: 104-111
[Abstract][Full Text]
Suryanarayanan, S., Karellas, A., Vedantham, S., Sechopoulos, I., D'Orsi, C. J.
(2007). Detection of Simulated Microcalcifications in a Phantom with Digital Mammography: Effect of Pixel Size. Radiology
244: 130-137
[Abstract][Full Text]
Jiang, Y., Miglioretti, D. L., Metz, C. E., Schmidt, R. A.
(2007). Breast Cancer Detection Rate: Designing Imaging Trials to Demonstrate Improvements. Radiology
243: 360-367
[Abstract][Full Text]
Samei, E., Saunders, R. S. Jr, Baker, J. A., Delong, D. M.
(2007). Digital Mammography: Effects of Reduced Radiation Dose on Diagnostic Performance. Radiology
243: 396-404
[Abstract][Full Text]
Hall, F. M.
(2007). Breast Imaging and Computer-Aided Detection. NEJM
356: 1464-1466
[Full Text]
Smith, R. A.
(2007). The Evolving Role of MRI in the Detection and Evaluation of Breast Cancer. NEJM
356: 1362-1364
[Full Text]
Lehman, C. D., Gatsonis, C., Kuhl, C. K., Hendrick, R. E., Pisano, E. D., Hanna, L., Peacock, S., Smazal, S. F., Maki, D. D., Julian, T. B., DePeri, E. R., Bluemke, D. A., Schnall, M. D., the ACRIN Trial 6667 Investigators Group,
(2007). MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast Cancer. NEJM
356: 1295-1303
[Abstract][Full Text]
(2007). The Utility of Screening Mammography. JWatch Women's Health
2007: 1-1
[Full Text]
Sickles, E. A.
(2007). Wolfe Mammographic Parenchymal Patterns and Breast Cancer Risk. Am. J. Roentgenol.
188: 301-303
[Full Text]
Skaane, P., Kshirsagar, A., Stapleton, S., Young, K., Castellino, R. A.
(2007). Effect of Computer-Aided Detection on Independent Double Reading of Paired Screen-Film and Full-Field Digital Screening Mammograms. Am. J. Roentgenol.
188: 377-384
[Abstract][Full Text]
Krug, K. B., Stutzer, H., Girnus, R., Zahringer, M., Gossmann, A., Winnekendonk, G., Lackner, K.
(2007). Image Quality of Digital Direct Flat-Panel Mammography Versus an Analog Screen-Film Technique Using a Phantom Model. Am. J. Roentgenol.
188: 399-407
[Abstract][Full Text]
Boyd, N. F., Guo, H., Martin, L. J., Sun, L., Stone, J., Fishell, E., Jong, R. A., Hislop, G., Chiarelli, A., Minkin, S., Yaffe, M. J.
(2007). Mammographic Density and the Risk and Detection of Breast Cancer. NEJM
356: 227-236
[Abstract][Full Text]
Kerlikowske, K.
(2007). The Mammogram That Cried Wolfe. NEJM
356: 297-300
[Full Text]
Saunders, R S, Samei, E
(2006). Improving mammographic decision accuracy by incorporating observer ratings with interpretation time. Br. J. Radiol.
79: S117-S122
[Abstract][Full Text]
Bondy, M. L., Newman, L. A.
(2006). Assessing breast cancer risk: evolution of the gail model.. JNCI J Natl Cancer Inst
98: 1172-1173
[Full Text]
Black, W. C.
(2006). Randomized Clinical Trials for Cancer Screening: Rationale and Design Considerations for Imaging Tests. JCO
24: 3252-3260
[Abstract][Full Text]
Kim, H. H., Pisano, E. D., Cole, E. B., Jiroutek, M. R., Muller, K. E., Zheng, Y., Kuzmiak, C. M., Koomen, M. A.
(2006). Comparison of calcification specificity in digital mammography using soft-copy display versus screen-film mammography.. Am. J. Roentgenol.
187: 47-50
[Abstract][Full Text]
Plevritis, S. K., Kurian, A. W., Sigal, B. M., Daniel, B. L., Ikeda, D. M., Stockdale, F. E., Garber, A. M.
(2006). Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging.. JAMA
295: 2374-2384
[Abstract][Full Text]
Irwig, L., Houssami, N., Armstrong, B., Glasziou, P.
(2006). Evaluating new screening tests for breast cancer.. BMJ
332: 678-679
[Full Text]
Dixon, J M.
(2006). Screening for breast cancer.. BMJ
332: 499-500
[Full Text]
Crystal, P., Strano, S., Keen, J. D., Ebell, M. H., Gatsonis, C., Pisano, E. D., Hendrick, E.
(2006). Digital and film mammography.. NEJM
354: 765-767
[Full Text]
Herbst, R. S., Bajorin, D. F., Bleiberg, H., Blum, D., Hao, D., Johnson, B. E., Ozols, R. F., Demetri, G. D., Ganz, P. A., Kris, M. G., Levin, B., Markman, M., Raghavan, D., Reaman, G. H., Sawaya, R., Schuchter, L. M., Sweetenham, J. W., Vahdat, L. T., Vokes, E. E., Winn, R. J., Mayer, R. J.
(2006). Clinical Cancer Advances 2005: Major Research Advances in Cancer Treatment, Prevention, and Screening--A Report From the American Society of Clinical Oncology. JCO
24: 190-205
[Abstract][Full Text]
Smith, R. A., Cokkinides, V., Eyre, H. J.
(2006). American Cancer Society Guidelines for the Early Detection of Cancer, 2006. CA Cancer J Clin
56: 11-25
[Abstract][Full Text]
BRUSIN, J. H.
(2006). Digital Mammography: An Update. radtech
77: 226M-234M
[Abstract][Full Text]
(2005). Mammography: Is Digital Better?. JWatch Women's Health
2005: 7-7
[Full Text]
(2005). Film vs. Digital Mammography. JWatch General
2005: 2-2
[Full Text]
Dershaw, D. D.
(2005). Film or digital mammographic screening?. NEJM
353: 1846-1847
[Full Text]
Spurgeon, D.
(2005). Digital mammography is more accurate only for certain groups of women. BMJ
331: 653-653
[Full Text]
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