Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), PO Box 19079, Utrecht, 3501, DB, The Netherlands.
BMC Cancer. 2018 Mar 5;18(1):256. doi: 10.1186/s12885-018-4122-2.
Between 2003 and 2010 digital mammography (DM) gradually replaced screen-film mammography (SFM) in the Dutch breast cancer screening programme (BCSP). Previous studies showed increases in detection rate (DR) after the transition to DM. However, national interval cancer rates (ICR) have not yet been reported.
We assessed programme sensitivity and specificity during the transition period to DM, analysing nationwide data on screen-detected and interval cancers. Data of 7.3 million screens in women aged 49-74, between 2004 and 2011, were linked to the Netherlands Cancer Registry to obtain data on interval cancers. Age-adjusted DRs, ICRs and recall rates (RR) per 1000 screens and programme sensitivity and specificity were calculated by year, age and screening modality.
41,662 screen-detected and 16,160 interval cancers were analysed. The DR significantly increased from 5.13 (95% confidence interval (CI):5.00-5.30) in 2004 to 6.34 (95% CI:6.15-6.47) in 2011, for both in situ (2004:0.73;2011:1.24) and invasive cancers (2004:4.42;2011:5.07), whereas the ICR remained stable (2004: 2.16 (95% CI2.06-2.25);2011: 2.13 (95% CI:2.04-2.22)). The RR changed significantly from 14.0 to 21.4. Programme sensitivity significantly increased, mainly between ages 49-59, from 70.0% (95% CI:68.9-71.2) to 74.4% (95% CI:73.5-75.4) whereas specificity slightly declined (2004:99.1% (95% CI:99.09-99.13);2011:98.5% (95% CI:98.45-98.50)). The overall DR was significantly higher for DM than for SFM (6.24;5.36) as was programme sensitivity (73.6%;70.1%), the ICR was similar (2.19;2.20) and specificity was significantly lower for DM (98.5%;98.9%).
During the transition from SFM to DM, there was a significant rise in DR and a stable ICR, leading to increased programme sensitivity. Although the recall rate increased, programme specificity remained high compared to other countries. These findings indicate that the performance of DM in a nationwide screening programme is not inferior to, and may be even better, than that of SFM.
2003 年至 2010 年间，数字乳腺 X 线摄影（DM）逐渐取代了乳腺 X 线摄影（SFM）在荷兰乳腺癌筛查计划（BCSP）中的地位。先前的研究表明，在向 DM 过渡后，检测率（DR）有所提高。然而，全国范围内的间隔癌发病率（ICR）尚未报告。
我们分析了过渡期间 DM 的计划敏感性和特异性，分析了全国范围内的屏幕检测和间隔性癌症数据。2004 年至 2011 年间，对 49-74 岁女性进行了 730 万次屏幕检测，将这些数据与荷兰癌症登记处进行了链接，以获取关于间隔性癌症的数据。按年份、年龄和筛查方式计算每 1000 次筛查的年龄调整后的 DR、ICR 和召回率（RR），并计算计划敏感性和特异性。
分析了 41662 例屏幕检测到的癌症和 16160 例间隔性癌症。DR 从 2004 年的 5.13（95%置信区间（CI）：5.00-5.30）显著增加到 2011 年的 6.34（95%CI：6.15-6.47），原位癌（2004 年：0.73；2011 年：1.24）和侵袭性癌症（2004 年：4.42；2011 年：5.07），而 ICR 保持稳定（2004 年：2.16（95%CI2.06-2.25）；2011 年：2.13（95%CI：2.04-2.22））。RR 从 14.0 显著变化至 21.4。计划敏感性显著增加，主要在 49-59 岁年龄组，从 70.0%（95%CI：68.9-71.2）增加到 74.4%（95%CI：73.5-75.4），而特异性略有下降（2004 年：99.1%（95%CI：99.09-99.13）；2011 年：98.5%（95%CI：98.45-98.50））。DM 的总体 DR 明显高于 SFM（6.24；5.36），计划敏感性（73.6%；70.1%）更高，ICR 相似（2.19；2.20），DM 的特异性明显低于 SFM（98.5%；98.9%）。
在从 SFM 过渡到 DM 的过程中，DR 显著上升，ICR 保持稳定，导致计划敏感性提高。尽管召回率有所增加，但与其他国家相比，计划特异性仍然很高。这些发现表明，DM 在全国性筛查计划中的性能并不逊于 SFM，甚至可能更好。
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