The impact of the BreastScreen NSW transition from film to digital mammography, 2002–2016: a linked population health data analysis

IF 6.7 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Medical Journal of Australia Pub Date : 2025-01-12 DOI:10.5694/mja2.52566

Rachel Farber, Nehmat Houssami, Kevin McGeechan, Alexandra L Barratt, Katy JL Bell

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Abstract

Objectives

To assess the impact of the transition from film to digital mammography in the Australian national breast cancer screening program.

Study design

Retrospective linked population health data analysis (New South Wales Central Cancer Registry, BreastScreen NSW); interrupted time series analysis.

Setting

New South Wales, 2002–2016.

Participants

Women aged 40 years or older with breast cancer diagnosed during 2002–2017 who had been screened by BreastScreen NSW and for whom complete follow-up information until the end of the recommended re-screening interval was available.

Intervention

Transition from film to digital mammography; 2009 defined as transition year (digital mammography becomes dominant screening modality).

Main outcome measures

Population rates of screen-detected cancer, interval cancer, recalls, and false positive findings.

Results

The study cohort comprised 967 573 women; of the 2 741 555 screens, 1 535 184 used film mammography (2002–2010) and 1 206 371 used digital mammography (2006–2016). The screen-detected cancer rate was 4.86 (95% confidence interval [CI], 4.75–4.97) cases per 1000 screens with film mammography and 6.11 (95% CI, 5.97–6.24) cases per 1000 screens with digital mammography (unadjusted difference, 1.24 [95% CI, 1.06–1.41] cases per 1000 screens). The interval cancer rate was 2.56 (95% CI, 2.48–2.64) cases per 1000 screens with film mammography and 2.84 (95% CI, 2.75–2.94) cases per 1000 screens with digital mammography (unadjusted difference, 0.27 [95% CI, 0.15–0.40] cases per 1000 screens). With the transition to digital mammography, the screen-detected cancer rate increased by 0.07 per 1000 screens, the sum of the decline in the invasive cancer rate (–0.21 cases per 1000 screens) and the rise in the ductal carcinoma in situ detection rate (0.28 cases per 1000 screens); during 2009–2015, it increased by 0.18 cases per 1000 screens per year. With the transition to digital mammography, the interval cancer rate increased by 0.75 cases per 1000 screens (invasive cancer: by 0.69 cases per 1000 screens); during 2009–2015, it declined by 0.13 cases per 1000 screens per year. The recall rate increased by 8.02 per 1000 screens and the false positive rate by 7.16 per 1000 screens following the transition; both rates subsequently declined to pre-transition levels.

Conclusions

The increased screen-detected cancer rate following the transition to digital mammography was not accompanied by a reduction in interval cancer detection rates.

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2002-2016年新南威尔士州乳房筛查从胶片乳房x光检查到数字乳房x光检查的影响：相关人口健康数据分析。

目的：评估从胶片乳房x线摄影到数字乳房x线摄影对澳大利亚国家乳腺癌筛查计划的影响。研究设计：回顾性关联人群健康数据分析（新南威尔士州中央癌症登记处，BreastScreen NSW）；中断时间序列分析。背景：新南威尔士州，2002-2016。参与者：在2002-2017年期间被诊断患有乳腺癌的40岁或以上的女性，她们接受过新南威尔士州乳房筛查筛查，并且在推荐的重新筛查间隔结束之前可以获得完整的随访信息。干预：从胶片乳房x光检查到数字乳房x光检查的过渡；2009年被定义为过渡年（数字乳房x光检查成为主要的筛查方式）。主要结局指标：筛查发现的癌症、间隔期癌症、召回率和假阳性结果的人口比率。结果：研究队列包括967 573名女性；在2741555个筛查中，1535184个使用胶片乳房x光检查（2002-2010年），1206371个使用数字乳房x光检查（2006-2016年）。胶片乳房x光检查的筛查癌率为4.86(95%可信区间[CI]， 4.75-4.97) / 1000例，数字乳房x光检查的筛查癌率为6.11 (95% CI, 5.97-6.24) / 1000例（未调整差异，1.24 [95% CI, 1.06-1.41]例/ 1000例）。间隔癌率为胶片乳房x光检查每1000个屏幕2.56例（95% CI, 2.48-2.64），数字乳房x光检查每1000个屏幕2.84例（95% CI, 2.75-2.94）（未经调整的差异，0.27 [95% CI, 0.15-0.40]例/ 1000个屏幕）。随着数字化乳房x线摄影的发展，浸润性癌的检出率下降（-0.21例/ 1000片），导管原位癌的检出率上升（0.28例/ 1000片），检出率增加0.07 / 1000片；在2009-2015年期间，每年每1000次筛查增加0.18例。随着向数字化乳房x线摄影的过渡，间隔期癌症发病率每1000次筛查增加0.75例（浸润性癌症：每1000次筛查增加0.69例）；在2009-2015年期间，每年每1000次筛查减少0.13例。转换后，召回率每1000个屏幕增加8.02个，假阳性率每1000个屏幕增加7.16个；这两个比率后来都下降到过渡前的水平。结论：过渡到数字乳房x线摄影后，增加的筛查检测癌症率并不伴随着间隔癌症检出率的降低。

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来源期刊

Medical Journal of Australia 医学-医学：内科

CiteScore

9.40

自引率

5.30%

发文量

410

审稿时长

3-8 weeks

期刊介绍： The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.