Transition from film to digital mammography: Impact for breast cancer screening through the national breast and cervical cancer early detection program

Nicolien T. Van Ravesteyn, Lisanne Van Lier, Clyde B. Schechter, Donatus U. Ekwueme, Janet Royalty, Jacqueline W. Miller, Aimee M. Near, Kathleen A. Cronin, Eveline A M Heijnsdijk, Jeanne S. Mandelblatt, Harry J. De Koning

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Introduction The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides mammograms and diagnostic services for low-income, uninsured women aged 40-64 years. Mammography facilities within the NBCCEDP gradually shifted from plain-film to digital mammography. The purpose of this study is to assess the impact of replacing film with digital mammography on health effects (deaths averted, life-years gained [LYG]); costs (for screening and diagnostics); and number of women reached. Methods NBCCEDP 2010 data and data representative of the program's target population were used in two established microsimulation models. Models simulated observed screening behavior including different screening intervals (annual, biennial, irregular) and starting ages (40, 50 years) for white, black, and Hispanic women. Model runs were performed in 2012. Results The models predicted 8.0-8.3 LYG per 1,000 film screens for black women, 5.9-7.5 for white women, and 4.0-4.5 for Hispanic women. For all race/ethnicity groups, digital mammography had more LYG than film mammography (2%-4%), but had higher costs (34%-35%). Assuming a fixed budget, 25%-26% fewer women could be served, resulting in 22%-24% fewer LYG if all mammograms were converted to digital. The loss in LYG could be reversed to an 8%-13% increase by only including biennial screening. Conclusions Digital could result in slightly more LYG than film mammography. However, with a fixed budget, fewer women may be served with fewer LYG. Changes in the program, such as only including biennial screening, will increase LYG/screen and could offset the potential decrease in LYG when shifting to digital mammography.

Original languageEnglish (US)
Pages (from-to)535-542
Number of pages8
JournalAmerican Journal of Preventive Medicine
Volume48
Issue number5
DOIs
StatePublished - May 1 2015

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Mammography
Early Detection of Cancer
Uterine Cervical Neoplasms
Breast Neoplasms
Budgets
Hispanic Americans
Diagnostic Services
Costs and Cost Analysis
Health Services Needs and Demand
Motion Pictures
Health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology

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Transition from film to digital mammography : Impact for breast cancer screening through the national breast and cervical cancer early detection program. / Van Ravesteyn, Nicolien T.; Van Lier, Lisanne; Schechter, Clyde B.; Ekwueme, Donatus U.; Royalty, Janet; Miller, Jacqueline W.; Near, Aimee M.; Cronin, Kathleen A.; Heijnsdijk, Eveline A M; Mandelblatt, Jeanne S.; De Koning, Harry J.

In: American Journal of Preventive Medicine, Vol. 48, No. 5, 01.05.2015, p. 535-542.

Research output: Contribution to journalArticle

Van Ravesteyn, NT, Van Lier, L, Schechter, CB, Ekwueme, DU, Royalty, J, Miller, JW, Near, AM, Cronin, KA, Heijnsdijk, EAM, Mandelblatt, JS & De Koning, HJ 2015, 'Transition from film to digital mammography: Impact for breast cancer screening through the national breast and cervical cancer early detection program', American Journal of Preventive Medicine, vol. 48, no. 5, pp. 535-542. https://doi.org/10.1016/j.amepre.2014.11.010
Van Ravesteyn, Nicolien T. ; Van Lier, Lisanne ; Schechter, Clyde B. ; Ekwueme, Donatus U. ; Royalty, Janet ; Miller, Jacqueline W. ; Near, Aimee M. ; Cronin, Kathleen A. ; Heijnsdijk, Eveline A M ; Mandelblatt, Jeanne S. ; De Koning, Harry J. / Transition from film to digital mammography : Impact for breast cancer screening through the national breast and cervical cancer early detection program. In: American Journal of Preventive Medicine. 2015 ; Vol. 48, No. 5. pp. 535-542.
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abstract = "Introduction The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides mammograms and diagnostic services for low-income, uninsured women aged 40-64 years. Mammography facilities within the NBCCEDP gradually shifted from plain-film to digital mammography. The purpose of this study is to assess the impact of replacing film with digital mammography on health effects (deaths averted, life-years gained [LYG]); costs (for screening and diagnostics); and number of women reached. Methods NBCCEDP 2010 data and data representative of the program's target population were used in two established microsimulation models. Models simulated observed screening behavior including different screening intervals (annual, biennial, irregular) and starting ages (40, 50 years) for white, black, and Hispanic women. Model runs were performed in 2012. Results The models predicted 8.0-8.3 LYG per 1,000 film screens for black women, 5.9-7.5 for white women, and 4.0-4.5 for Hispanic women. For all race/ethnicity groups, digital mammography had more LYG than film mammography (2{\%}-4{\%}), but had higher costs (34{\%}-35{\%}). Assuming a fixed budget, 25{\%}-26{\%} fewer women could be served, resulting in 22{\%}-24{\%} fewer LYG if all mammograms were converted to digital. The loss in LYG could be reversed to an 8{\%}-13{\%} increase by only including biennial screening. Conclusions Digital could result in slightly more LYG than film mammography. However, with a fixed budget, fewer women may be served with fewer LYG. Changes in the program, such as only including biennial screening, will increase LYG/screen and could offset the potential decrease in LYG when shifting to digital mammography.",
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AU - Ekwueme, Donatus U.

AU - Royalty, Janet

AU - Miller, Jacqueline W.

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N2 - Introduction The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides mammograms and diagnostic services for low-income, uninsured women aged 40-64 years. Mammography facilities within the NBCCEDP gradually shifted from plain-film to digital mammography. The purpose of this study is to assess the impact of replacing film with digital mammography on health effects (deaths averted, life-years gained [LYG]); costs (for screening and diagnostics); and number of women reached. Methods NBCCEDP 2010 data and data representative of the program's target population were used in two established microsimulation models. Models simulated observed screening behavior including different screening intervals (annual, biennial, irregular) and starting ages (40, 50 years) for white, black, and Hispanic women. Model runs were performed in 2012. Results The models predicted 8.0-8.3 LYG per 1,000 film screens for black women, 5.9-7.5 for white women, and 4.0-4.5 for Hispanic women. For all race/ethnicity groups, digital mammography had more LYG than film mammography (2%-4%), but had higher costs (34%-35%). Assuming a fixed budget, 25%-26% fewer women could be served, resulting in 22%-24% fewer LYG if all mammograms were converted to digital. The loss in LYG could be reversed to an 8%-13% increase by only including biennial screening. Conclusions Digital could result in slightly more LYG than film mammography. However, with a fixed budget, fewer women may be served with fewer LYG. Changes in the program, such as only including biennial screening, will increase LYG/screen and could offset the potential decrease in LYG when shifting to digital mammography.

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