Abstract
In 2012, the Reggio Emilia Breast Cancer Screening Program introduced digital mammography in all its facilities at the same time. The aim of this work is to analyze the impact of digital mammography introduction on the recall rate, detection rate, and positive predictive value. The program actively invites women aged 45–74 years. We included women screened in 2011, all of whom underwent film-screen mammography, and all women screened in 2012, all of whom underwent digital mammography. Double reading was used for all mammograms, with arbitration in the event of disagreement. A total of 42,240 women underwent screen-film mammography and 45,196 underwent digital mammography. The recall rate increased from 3.3 to 4.4 % in the first year of digital mammography (relative recall adjusted by age and round 1.46, 95 % CI = 1.37–1.56); the positivity rate for each individual reading, before arbitration, rose from 3 to 5.7 %. The digital mammography recall rate decreased during 2012: after 12 months, it was similar to the recall rate with screen-film mammography. The detection rate was similar: 5.9/1000 and 5.2/1000 with screen-film and digital mammography, respectively (adjusted relative detection rate 0.95, 95 % CI = 0.79–1.13). The relative detection rate for ductal carcinoma in situ remained the same. The introduction of digital mammography to our organized screening program had a negative impact on specificity, thereby increasing the recall rate. The effect was limited to the first 12 months after introduction and was attenuated by the double reading with arbitration. We did not observe any relevant effects on the detection rate.
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Authors’ Contribution
Study concepts were contributed by PGR, PP, and CC. Study design was done by PGR and CC. Data acquisition was performed by PM, CC, PP, and SR. Quality control of data and algorithms was ensured by PM. Data analysis and interpretation were done by PGR, PM, and CC. Statistical analysis was performed by PM and CC. Manuscript preparation was done by PGR. Manuscript editing and review were done by all authors.
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This study was conducted in accordance with the routine quality assurance procedures established by the Local Health Authority for its screening programs. The Reggio Emilia Cancer Registry, which routinely collects the screening history of each case of breast cancer, has been approved by the Provincial Ethic Committee.
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Key Points
• The introduction of digital mammography in screening produced an initial increase in the recall rate.
• After 12 months, the recall rate returned to the levels achieved with screen-film mammography.
• We did not observe any effects on the detection rate.
• We did not observe any increase in ductal carcinoma in situ (DCIS) detection.
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Campari, C., Rossi, P.G., Mori, C.A. et al. Impact of the Introduction of Digital Mammography in an Organized Screening Program on the Recall and Detection Rate. J Digit Imaging 29, 235–242 (2016). https://doi.org/10.1007/s10278-015-9843-z
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DOI: https://doi.org/10.1007/s10278-015-9843-z