Digital mammography screening: Weighing reduced mortality against increased overdiagnosis

作者：de Gelder Rianne^*; Fracheboud Jacques; Heijnsdijk Eveline A M; den Heeten Gerard; Verbeek Andre L M; Broeders Mireille J M; Draisma Gerrit; de Koning Harry J

来源：Preventive Medicine, 2011, 53(3): 134-140.

DOI：10.1016/j.ypmed.2011.06.009

• Breast neoplasms
• Mass screening
• Early diagnosis
• Mammography
• Carcinoma
• Intraductal
• Noninfiltrating
• Computer Simulation
• Risk assessment
• Mortality

Objective: Digital 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.
Methods: Breast 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.
Results: The 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).
Conclusion: Modeling 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.

• 出版日期2011-9-1