• Jacky D Luiten, Adri C Voogd, LuitenErnest J TEJTDepartment of Breast Surgery, Amphia Hospital, Molengracht 21, 4818CK, Breda, The Netherlands., and DuijmLucien E MLEMhttp://orcid.org/0000-0001-7374-2257Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532SZ, Nijmegen, The Netherlands. lemduijm@hotmail.com.Dutch Reference Centre for Screening, Wijchenseweg 101, 6538SW, Ni.
• Faculty of Medicine and Health Sciences, Erasmus University, University Medical Centre, 's-Gravendijkwal 230, 3015CE, Rotterdam, The Netherlands.
• Breast Cancer Res. Treat. 2017 Nov 1; 166 (1): 307-314.

PurposeIn a biennial screening mammography programme, we analysed the trends in incidence of screen-detected DCIS and invasive breast cancers in the era of screen-film mammography (SFM) screening, the period of the transition to full-field digital mammography (FFDM) screening and the period of FFDM screening. We also investigated a possible association between the incidence and grading of screen-detected DCIS and invasive breast cancer.MethodsIn the southern part of the Netherlands, FFDM screening gradually replaced SFM screening between May 2009 and April 2010. We included a consecutive series of 484, 422 screens obtained between July 2005 and July 2015 and divided these screens into three groups; SFM-only cohort, transition cohort and FFDM-only cohort.ResultsA total of 3059 referred women were diagnosed with DCIS (n = 623) or invasive breast cancer (n = 2436). The majority of DCIS were high-grade (48.2%), whereas the majority of the invasive breast cancers were low-grade (45.4%) or intermediate-grade (41.6%). The cancer detection rate (CDR) per 1000 screened women showed the same distribution by grade in both groups. The transition to FFDM was characterised by an increased overall detection rate of invasive cancers.ConclusionsScreening mammography detects mostly high-grade DCIS and low- or intermediate-grade invasive cancers. The grade distribution as well as the CDR in the years after the introduction of FFDM remained stable compared to the era of SFM screening. By diagnosing and treating high-grade DCIS, which otherwise may develop into high-grade invasive carcinoma, our findings provide new evidence for the beneficial value of screening mammography programmes.

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