Full-Field Digital Mammography Reduces Recall and Biopsy Rates

Use of full-field digital mammography (FFDM) results in lower recall and biopsy rates, and higher positive predictive values after biopsy than does screen film mammography (SFM), according to a study published in the journal Radiology.

Researchers from Norway sought to compare the accuracy of FFDM with SFM during a transition phase of adoption of screening from SFM to FFDM in the Norwegian Breast Cancer Screening Program. The researchers analyzed data of women aged 50 to 69 who were enrolled in the program from 1996 to 2010. When the program began, the women underwent SFM screening. Starting in 2000, FFDM was gradually implemented throughout the program.

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“The program invites women age 50 to 69 years to mammographic screening every two years,” co-author Soveig Hofvind, PhD, said in a release. “We analyzed performance measures in the program as run in a usual setting.”

A total of 1,391,118 SFM and 446,172 FFDM screenings were performed. There were women in the study who had undergone SFM or FFDM only, but many women had multiple screenings during the study period with both SFM and FFDM screenings. The researchers looked at the equality of proportions of recall rates, positive predictive value of recall examinations and invasive procedures, as well as rates of screening-detected and interval cancers.

The results showed an overall recall rate of 3.4 percent for SFM and 2.9 percent for FFDM. The biopsy rate was 1.4 percent for SFM and 1.1 percent for FFDM. “The rate of screening-detected ductal carcinoma in situ was higher while the rate of invasive breast cancer was lower for FFDM compared with those for SFM,” the authors wrote. “The rate for both invasive screening-detected and interval breast cancer remained stable during the transition from SFM to FFDM (when the previous examination was SFM) and after FFDM was firmly established.”

The positive predictive value of recalled examinations and biopsy procedures rose from 19.3 percent and 48.3 percent, to 22.7 percent and 57.5 percent, respectively, after FFDM was adopted.

The researchers concluded that after the initial transition phase from SFM to FFDM, population-based screening with FFDM was more effective in reducing the number of recall and biopsy rates, while maintaining higher positive predictive values.