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Digital mammography has advantages in breast cancer screening
Last Updated: 2005-09-16 15:51:08 -0400 (Reuters Health)
NEW YORK (Reuters Health) - As a screening measure for breast cancer, digital mammography is more accurate than film mammography at detecting disease in women with dense breasts, women under 50 years of age, and pre- or perimenopausal women, according to a report published September 16th in The New England Journal of Medicine.
Film mammography is limited in its ability to detect cancer in radiologically dense breasts, according to the researchers. Digital mammography was developed to address this and other limitations of film mammography. With this newer technique, the contrast of the image can be adjusted, making it easier to visualize dense regions.
However, despite this and other apparent advantages of digital mammography, previous studies have failed to show that it is significantly more accurate than film mammography, lead author Dr. Etta D. Pisano, from the University of North Carolina in Chapel Hill, and colleagues note. However, these studies only used one type of digital detector and did not have enough statistical power to detect small differences in accuracy.
In the Digital Mammographic Imaging Screening Trial (DMIST), 49,528 asymptomatic women were screened for breast cancer with both digital and film mammography. Two radiologists independently interpreted the mammograms.
Complete data was available for 86.3% of the study participants. Breast cancer status was determined through biopsy within 15 months of study entry or with repeat mammograms at least 15 months after study entry.
The researchers compared film mammograms with digital mammograms from systems made by Fischer Imaging, Fuji Photo Film Co. Ltd., General Electric Co. and Hologic Inc. All but the Fuji system are approved by the Food and Drug Administration and available for use in the United States.
In the overall analysis, digital and film mammography were similar in their ability to identify breast cancer. As noted, however, digital mammography was significantly more accurate than film mammography at detecting cancer in young women, women with dense breasts, and premenopausal and perimenopausal women.
While these findings are encouraging, the adoption of digital mammography as a routine screening measure will likely depend on another factor: cost.
"Digital systems currently cost approximately 1.5 to 4 times as much as film systems," the researchers point out. "As part of DMIST, we are performing a formal cost-effectiveness analysis and study of the quality of life of asymptomatic women.
N Engl J Med 2005;353.
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