Abstract

Background

Breast screening programs replaced film mammography with digital mammography, and the effects of this practice shift in population screening on health outcomes can be measured through examination of cancer detection and interval cancer rates.

Methods

A systematic review and random effects meta-analysis were undertaken. Seven databases were searched for publications that compared film with digital mammography within the same population of asymptomatic women and reported cancer detection and/or interval cancer rates.

Results

The analysis included 24 studies with 16 583 743 screening examinations (10 968 843 film and 5 614 900 digital). The pooled difference in the cancer detection rate showed an increase of 0.51 per 1000 screens (95% confidence interval [CI] = 0.19 to 0.83), greater relative increase for ductal carcinoma in situ (25.2%, 95% CI = 17.4% to 33.5%) than invasive (4%, 95% CI = −3% to 13%), and a recall rate increase of 6.95 (95% CI = 3.47 to 10.42) per 1000 screens after the transition from film to digital mammography. Seven studies (80.8% of screens) reported interval cancers: the pooled difference showed no change in the interval cancer rate with −0.02 per 1000 screens (95% CI = −0.06 to 0.03). Restricting analysis to studies at low risk of bias resulted in findings consistent with the overall pooled results for all outcomes.

Conclusions

The increase in cancer detection following the practice shift to digital mammography did not translate into a reduction in the interval cancer rate. Recall rates were increased. These results suggest the transition from film to digital mammography did not result in health benefits for screened women. This analysis reinforces the need to carefully evaluate effects of future changes in technology, such as tomosynthesis, to ensure new technology leads to improved health outcomes and beyond technical gains.

中文翻译：

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全场数字化乳腺X线摄影术与胶片屏幕乳腺X线摄影术在人群筛查中的影响：一项荟萃分析。

摘要

背景

乳房筛查计划用数字乳腺X线摄影术代替了胶片乳腺X线摄影术，这种人群转移实践对健康结果的影响可以通过检查癌症检测率和间歇性癌症发生率来衡量。

方法

进行了系统的审查和随机效应荟萃分析。在七个数据库中搜索了出版物，这些出版物比较了相同无症状女性人群中的胶片和数字乳腺摄影，并报告了癌症检测和/或间歇性癌症发生率。

结果

分析包括24项研究，包括16 583 743场放映检查（10 968 843电影和5 614 900数字电影）。汇总的癌症检出率差异显示每1000个筛查增加0.51（95％置信区间[CI] = 0.19至0.83），原位导管癌相对增加更大（25.2％，95％CI = 17.4％至33.5） ％）比侵入式检查（4％，95％CI = -3％至13％），从胶片到数字化乳腺X线摄影后的每1000个屏幕，召回率提高了6.95（95％CI = 3.47至10.42）。七项研究（占筛查的80.8％）报告了间隔癌：汇总的差异显示间隔癌发生率没有变化，每1000筛查为-0.02（95％CI = -0.06至0.03）。将分析限制在偏倚风险低的研究中，可以得出与所有结果的总体合并结果一致的发现。

结论

从实践转向数字化乳腺摄影后，癌症检测的增加并未转化为间隔癌症率的降低。召回率提高了。这些结果表明，从胶片到数字乳腺X线摄影的过渡并未为受筛查的妇女带来健康益处。该分析强调需要仔细评估未来技术变化（例如断层合成）的影响，以确保新技术能够改善健康状况并超越技术收益。