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Digital compared to screen-film mammography: breast cancer prognostic features in an organized screening program

  • Epidemiology
  • Published:
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Abstract

Our previous study found cancer detection rates were equivalent for direct radiography compared to screen-film mammography, while rates for computed radiography were significantly lower. This study compares prognostic features of invasive breast cancers by type of mammography. Approved by the University of Toronto Research Ethics Board, this study identified invasive breast cancers diagnosed among concurrent cohorts of women aged 50–74 screened by direct radiography, computed radiography, or screen-film mammography from January 1, 2008 to December 31, 2009. During the study period, 816,232 mammograms were performed on 668,418 women, and 3,323 invasive breast cancers were diagnosed. Of 2,642 eligible women contacted, 2,041 participated (77.3 %). The final sample size for analysis included 1,405 screen-detected and 418 interval cancers (diagnosed within 24 months of a negative screening mammogram). Polytomous logistic regression was performed to evaluate the association between tumour characteristics and type of mammography, and between tumour characteristics and detection method. Odds ratios (OR) and 95 % confidence intervals (CI) were recorded. Cancers detected by computed radiography compared to screen-film mammography were significantly more likely to be lymph node positive (OR 1.94, 95 %CI 1.01–3.73) and have higher stage (II:I, OR 2.14, 95 %CI 1.11–4.13 and III/IV:I, OR 2.97, 95 %CI 1.02–8.59). Compared to screen-film mammography, significantly more cancers detected by direct radiography (OR 1.64, 95 %CI 1.12–2.38) were lymph node positive. Interval cancers had worse prognostic features compared to screen-detected cancers, irrespective of mammography type. Screening with computed radiography may lead to the detection of cancers with a less favourable stage distribution compared to screen-film mammography that may reflect a delayed diagnosis. Screening programs should re-evaluate their use of computed radiography for breast screening.

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Acknowledgments

The authors thank the study staff, Anjana Aery and Amanda Veglia, the women who participated in the study, and Cancer Care Ontario for the use of its data.

Conflict of interest

There are no conflicts of interest to disclose.

Funding

This work was supported by the Canadian Breast Cancer Research Alliance and the Canadian Institutes of Health Research (Grant #102603). These agencies had no involvement in the study or the decision to approve for publication.

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Authors and Affiliations

  1. Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada

    Maegan V. Prummel, Derek Muradali, Vicky Majpruz, Patrick Brown, Hedy Jiang, Rene S. Shumak & Anna M. Chiarelli

  2. Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Canada

    Susan J. Done

  3. University of Toronto, Toronto, Canada

    Susan J. Done, Patrick Brown, Claire M. B. Holloway & Anna M. Chiarelli

  4. Sunnybrook Health Sciences Centre, Toronto, Canada

    Claire M. B. Holloway

  5. Imaging Research, Sunnybrook Health Sciences Centre, Toronto, Canada

    Martin J. Yaffe

Authors
  1. Maegan V. Prummel
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  2. Susan J. Done
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Correspondence to Maegan V. Prummel.

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Prummel, M.V., Done, S.J., Muradali, D. et al. Digital compared to screen-film mammography: breast cancer prognostic features in an organized screening program. Breast Cancer Res Treat 147, 389–399 (2014). https://doi.org/10.1007/s10549-014-3088-2

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  • DOI: https://doi.org/10.1007/s10549-014-3088-2

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