Comparing digital and film mammography

While digital mammography may not be cost-effective for all women, according to results from the Digital Mammography Imaging Screening Trial (DMIST) and other available US data, using the technology on certain groups may increase its value.

Researchers compared all-film, all-digital, and targeted digital screening, which consists of age-targeted digital mammography for women younger than 50 and age- and density-targeted digital mammography for women younger than 50, or women 50 years or older with dense breasts.

They calculated that all-digital screening would cost $331,000 (95% CI, $268,000-$403,000) more per quality-adjusted life-year (QALY) gained than traditional all-film screening. Furthermore, it was less effective than targeted digital screening, which resulted in more screen-detected cases of cancer and fewer deaths from cancer than either of the other methods.

Age-targeted digital screening, on the other hand, cost only $26,500 (CI, $21,000-$33,000) more per QALY gained than all-film screening. Age- and density-targeted screening cost $84,000 (CI, $75,000-$93,000) more per QALY gained than film.

Tosteson AN, Stout NK, Fryback DG, et al. Cost-effectiveness of digital mammography breast cancer screening. Ann Intern Med. 2008;148:1-10.

Commentary from Nanette F. Santoro, MD, Professor and Director, Division of Reproductive Endocrinology, Department of Ob/Gyn and Women's Health, Albert Einstein College of Medicine, Bronx, NY.

Every now and then, we learn that less is more. In the article by Tosteson, screening with film mammography, and selective use of digital mammography were not only less costly but were more effective in detecting cancer and reducing deaths from cancer. The key to the effectiveness of digital mammography is targeting the procedure on the basis of age and breast density. In a follow-up study in Radiology, the DMIST group found that younger women (who have the highest proportion of dense breasts on mammography) fare particularly well when they have digital mammography performed. We can look forward to more useful information for clinicians from this important study as the data unfold.