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Digital mammography screening: sensitivity of the programme dependent on breast density

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To analyse the impact of breast density on the sensitivity of a population-based digital mammography screening programme (SP) as key evaluation parameter.


25,576 examinations were prospectively stratified from ACR category 1 to 4 for increments of 25 % density during independent double reading. SP was calculated as number of screen-detected cancers divided by the sum of screen-detected plus interval cancers (24-months period) per ACR category, related to the first reading (a), second reading (b) and highest stratification if discrepant (c). Chi-square tests were used for comparison.


Overall sensitivity of the programme was 79.9 %. SP in ACR 4 (a: 50 %, b: 50 %, c: 50 %) was significantly lower than in ACR 3 (a: 72.9 %, b: 79.4 %, c: 80.7 %, p < 0.001), ACR 2 (a: 83.9 %, b: 85.7 %, c: 83.2 %, p < 0.001) and ACR 1 (a: 100 %, b: 88.8 %, c: 100 %; p < 0.001). Frequencies of ACR 4 were a: 5.0 %, b: 4.3 %, c: 6.9 %.


Digital mammography screening with independent double reading leads to a high overall SP. In the small group of women with breast density classified as ACR 4 SP is significantly reduced compared to all other ACR categories.

Key Points

Overall sensitivity of a population-based digital mammography screening programme (SP) was 79.9 %.

In women with ACR 1, 2, or 3, SP ranged between 72.9 %-100 %.

ACR 4 was rare in participants (<7 %) and SP was only 50 %.

SP in ACR 4 differed significantly from ACR 3 (p < 0.001).

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American College of Radiology


Breast Imaging Reporting and Data System


Research Ethics Committee


Ductal carcinoma in situ


Sensitivity of the screening programme


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The scientific guarantor of this publication are Stefanie Weigel and Hans-Werner Hense. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Prof. Hense) has significant statistical expertise. Institutional Review Board approval was not required under national law. Written informed consent was waived by the Institutional Review Board. Some of the study subjects have been previously reported in:

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Weigel S, Heindel W, Heidrich J, Heidinger O, Hense HW. Reduction of Advanced Breast Cancer Stages at Subsequent Participation in Mammography Screening. Rofo. 2016 Jan;188(1):33–7.

Methodology: retrospective, observational, performed at one institution.

We especially acknowledge the continuous and excellent support of our screening team.

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Correspondence to Stefanie Weigel.

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Joint first (Weigel, Heindel) and joint last authorship (Hense, Heidinger)

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Weigel, S., Heindel, W., Heidrich, J. et al. Digital mammography screening: sensitivity of the programme dependent on breast density. Eur Radiol 27, 2744–2751 (2017).

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