Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.
J Natl Cancer Inst. 2021 Jan 4;113(1):16-26. doi: 10.1093/jnci/djaa080.
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.
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.
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.
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.
乳房筛查计划用数字 mammography 取代胶片 mammography，这种在人群筛查中实践转移对健康结果的影响可以通过检查癌症检出率和间隔期癌症率来衡量。
进行了系统评价和随机效应荟萃分析。在相同的无症状女性人群中，对比较胶片和数字 mammography 并报告癌症检出率和/或间隔期癌症率的出版物进行了 7 个数据库检索。
该分析包括 24 项研究，涉及 16583743 次筛查检查（10968843 次胶片和 5614900 次数字）。癌症检出率的汇总差异显示，每 1000 次筛查增加 0.51（95%置信区间[CI]为 0.19 至 0.83），导管原位癌（25.2%，95%CI 为 17.4%至 33.5%）的相对增加大于浸润性癌（4%，95%CI 为-3%至 13%），并且从胶片到数字 mammography 的过渡后，召回率增加了 6.95（95%CI 为 3.47 至 10.42）/每 1000 次筛查。7 项研究（80.8%的筛查）报告了间隔期癌症：汇总差异显示间隔期癌症率没有变化，为每 1000 次筛查减少 0.02（95%CI 为-0.06 至 0.03）。将分析仅限于低偏倚风险的研究，结果与所有结局的总体汇总结果一致。
向数字 mammography 实践转变后癌症检出率的增加并没有转化为间隔期癌症率的降低。召回率增加。这些结果表明，从胶片向数字 mammography 的过渡并没有给接受筛查的女性带来健康益处。该分析强调需要仔细评估未来技术变化（如断层合成术）的影响，以确保新技术带来改善的健康结果，并超越技术收益。
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