RespiteMatch.com Health Blog

By Peggy Peck , MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco

Source News Article: MSNBC
MedPage Today Action Points

Tell women that digital mammography is a relatively new technology that is not available in all centers.
Advise women that some insurers may not pay for use of digital mammography.
Explain that the study found that both plain film and digital mammography were effective screening tools.

Review
ARLINGTON, Va., Sept. 16-Digital mammography was significantly more accurate in detecting premenopausal breast cancer than traditional film-based mammography, researchers reported today on the basis of a study of nearly 50,000 women.

In the study, which was funded by the National Cancer Institute, digital mammography performed significantly better than film mammography among women younger than 50 years compared with those who were at least 50 (P=0.002).

Moreover, digital mammography was more accurate than film mammography among women with heterogeneously dense or extremely dense breasts (P=0.003).

The results were reported this morning at the American College of Radiology Imaging Network (ACRIN) meeting here by Etta D. Pisano, M.D., of the University of North Carolina at Chapel Hill for colleagues of the Digital Mammographic Imaging Screening Trial (DMIST). Concurrently, the results were published online by The New England Journal of Medicine.

The investigators said the improved accuracy in younger women and women with dense breasts “justifies use of digital mammography in these groups.”

Researchers at 33 sites in the U.S. and Canada enrolled 49,528 asymptomatic women who underwent both film and digital mammography screening. Data from mammography screening in 42,760 women were included in the analysis.

The mammograms were interpreted independently by two radiologists and breast cancer status was ascertained by breast cancer biopsy within 15 months after study entry or by follow-up mammogram within 10 months after study entry.

Among the findings:

In women younger than 50 the difference in the area under curve (AUC) was 0.15; 95% CI 0.05 to 0.25; P=0.002.

In women with heterogeneously dense or extremely dense breasts on mammography the AUC difference was 0.11; 95% CI 0.04 to 0.18; P=0.003.

For premenopausal or perimenopausal women the AUC difference was 0.15 95% CI 0.05 to 0.24; P=0.002.

Dr. Pisano and colleagues pointed out, however, that there “was no significant difference in diagnostic accuracy between digital and film mammography in the population as a whole or in other predefined subgroups.”

But the DMIST investigators added that digital mammography has a number of other advantages over plain film mammography, “namely, easier access to images and computer-assisted diagnosis; improved means of transmission, retrieval, and storage of images; and the use of a lower average dose of radiation.”

Finally, the researchers said that cost is likely to be a major impediment to the use of digital mammography because “digital systems currently cost approximately 1.5 to four times as much as plain film systems.”

Primary source: The New England Journal of Medicine
Source reference:
Pisano E D “Diagnostic Performance of Digital versus Film Mammography for Breast-Cancer Screening.” N Engl J Med 2005;353.
View this abstract.

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