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Screen-detected versus interval cancers: Effect of imaging modality and breast density in the Flemish Breast Cancer Screening Programme

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Abstract

Objectives

To investigate if direct radiography (DR) performs better than screen-film mammography (SF) and computed radiography (CR) in dense breasts in a decentralized organised Breast Cancer Screening Programme. To this end, screen-detected versus interval cancers were studied in different BI-RADS density classes for these imaging modalities.

Methods

The study cohort consisted of 351,532 women who participated in the Flemish Breast Cancer Screening Programme in 2009 and 2010. Information on screen-detected and interval cancers, breast density scores of radiologist second readers, and imaging modality was obtained by linkage of the databases of the Centre of Cancer Detection and the Belgian Cancer Registry.

Results

Overall, 67% of occurring breast cancers are screen detected and 33% are interval cancers, with DR performing better than SF and CR. The interval cancer rate increases gradually with breast density, regardless of modality. In the high-density class, the interval cancer rate exceeds the cancer detection rate for SF and CR, but not for DR.

Conclusions

DR is superior to SF and CR with respect to cancer detection rates for high-density breasts. To reduce the high interval cancer rate in dense breasts, use of an additional imaging technique in screening can be taken into consideration.

Key Points

• Interval cancer rate increases gradually with breast density, regardless of modality.

• Cancer detection rate in high-density breasts is superior in DR.

• IC rate exceeds CDR for SF and CR in high-density breasts.

• DR performs better in high-density breasts for third readings and false-positives.

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Acknowledgements

We wish to thank all members of the research working group and the general working group of the Breast Cancer Screening of the Flemish Government for their contribution. Special thanks go to the colleagues of the physical-technical quality assurance of LUCMFR, VUB and Controlatom. We also express our gratitude to VolparaSolutions® for use of the scientific version of VolparaDensity® software. Finally, last but not least, we wish to thank the Centres for Cancer Detection and the National Cancer Registry.

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Authors and Affiliations

  1. Department of Basic Medical Sciences, QCC-Gent, Ghent University, Ghent, Belgium

    Lore Timmermans, Klaus Bacher & Hubert Thierens

  2. Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Ghent University, Ghent, Belgium

    Luc Bleyen & Koen Van Herck

  3. Department of Radiology, University Hospitals Leuven, Leuven, Belgium

    Kim Lemmens, Chantal Van Ongeval & Andre Van Steen

  4. Centrum voor Kankeropsporing, Bruges, Belgium

    Patrick Martens

  5. Belgian Cancer Registry, Brussels, Belgium

    Isabel De Brabander

  6. Dienst Kankerpreventie, UZ Brussel, Brussels, Belgium

    Mathieu Goossens

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  1. Lore Timmermans
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Correspondence to Lore Timmermans.

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Guarantor

The scientific guarantor of this publication is Prof. Hubert Thierens

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was not required because the data were collected routinely in the context of a screening programme.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Women who participated in the screening programme gave their consent for collection of the data.

This consent includes allowing the use of the data for several projects, as for this evaluation.

Methodology

• retrospective

• observational

• multicentre study

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Timmermans, L., Bleyen, L., Bacher, K. et al. Screen-detected versus interval cancers: Effect of imaging modality and breast density in the Flemish Breast Cancer Screening Programme. Eur Radiol 27, 3810–3819 (2017). https://doi.org/10.1007/s00330-017-4757-4

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  • DOI: https://doi.org/10.1007/s00330-017-4757-4

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