Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program

Nataliia Moshina; Giske Ursin; Marta Roman; Sofie Sebuødegård; Solveig Hofvind

doi:10.1016/j.ejrad.2015.11.030

Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program

Eur J Radiol. 2016 Jan;85(1):248-254. doi: 10.1016/j.ejrad.2015.11.030. Epub 2015 Nov 25.

Authors

Nataliia Moshina¹, Giske Ursin², Marta Roman³, Sofie Sebuødegård⁴, Solveig Hofvind⁵

Affiliations

¹ Cancer Registry of Norway, Oslo, Norway. Electronic address: Nataliia.Moshina@kreftregisteret.no.
² Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, Medical Faculty, University of Oslo, Oslo, Norway; Department of Preventive Medicine, University of Southern California, CA, USA. Electronic address: Giske.Ursin@kreftregisteret.no.
³ Cancer Registry of Norway, Oslo, Norway; Department of Women and Children's Health, Oslo University Hospital, Oslo, Norway. Electronic address: Marta.Roman@kreftregisteret.no.
⁴ Cancer Registry of Norway, Oslo, Norway. Electronic address: Sofie.Sebuodegard@kreftregisteret.no.
⁵ Cancer Registry of Norway, Oslo, Norway; Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway. Electronic address: Solveig.Hofvind@kreftregisteret.no.

PMID: 26724673
DOI: 10.1016/j.ejrad.2015.11.030

Abstract

Objective: To investigate the probability of breast cancer among women recalled due to abnormal findings on the screening mammograms (PPV-1) and among women who underwent an invasive procedure (PPV-2) by mammographic density (MD), screening mode and age.

Methods: We used information about 28,826 recall examinations from 26,951 subsequently screened women in the Norwegian Breast Cancer Screening Program, 1996-2010. The radiologists who performed the recall examinations subjectively classified MD on the mammograms into three categories: fatty (<30% fibroglandular tissue); medium dense (30-70%) and dense (>70%). Screening mode was defined as screen-film mammography (SFM) and full-field digital mammography (FFDM). We examined trends of PPVs by MD, screening mode and age. We used logistic regression to estimate odds ratio (OR) of screen-detected breast cancer associated with MD among women recalled, adjusting for screening mode and age.

Results: PPV-1 and PPV-2 decreased by increasing MD, regardless of screening mode (p for trend <0.05 for both PPVs). PPV-1 and PPV-2 were statistically significantly higher for FFDM compared with SFM for women with fatty breasts. Among women recalled, the adjusted OR of breast cancer decreased with increasing MD. Compared with women with fatty breasts, the OR was 0.90 (95% CI: 0.84-0.96) for those with medium dense breasts and 0.85 (95% CI: 0.76-0.95) for those with dense breasts.

Conclusion: PPVs decreased by increasing MD. Fewer women needed to be recalled or undergo an invasive procedure to detect one breast cancer among those with fatty versus dense breasts in the screening program in Norway, 1996-2010.

Keywords: Breast cancer screening; Mammographic density; Positive predictive value; Screening mode.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Breast Density
Breast Neoplasms / diagnostic imaging*
Early Detection of Cancer / methods*
Female
Humans
Mammary Glands, Human / abnormalities*
Mass Screening / methods*
Middle Aged
Norway
Predictive Value of Tests
Radiographic Image Enhancement / methods
Reproducibility of Results