• Natasha K Stout, Sandra J Lee, Clyde B Schechter, Karla Kerlikowske, Oguzhan Alagoz, Donald Berry, Diana S M Buist, Mucahit Cevik, Gary Chisholm, Harry J de Koning, Hui Huang, Rebecca A Hubbard, Diana L Miglioretti, Mark F Munsell, Amy Trentham-Dietz, Nicolien T van Ravesteyn, Anna N A Tosteson, and Jeanne S Mandelblatt.
• Affiliations of authors: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA (NKS); Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA (SJL, HH); Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (CBS); Departments of Epidemiology and Biostatistics, and General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA (KK); Department of Industrial and Systems Engineering (OA, MC) and Department of Population Health Sciences and Carbone Cancer Center (OA, AT-D), University of Wisconsin, Madison, WI; Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX (DB, GC, MFM); Group Health Research Institute, Seattle, WA (DSMB, RAH); Department of Public Health, Erasmus MC, Rotterdam, The Netherlands (HJdK, NTvR); Department of Public Health Sciences, School of Medicine, University of California, Davis, California (DLM); Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH (ANAT); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC (JSM). natasha_stout@hms.harvard.edu.
• J. Natl. Cancer Inst. 2014 Jun 1; 106 (6): dju092.

BackgroundCompared with film, digital mammography has superior sensitivity but lower specificity for women aged 40 to 49 years and women with dense breasts. Digital has replaced film in virtually all US facilities, but overall population health and cost from use of this technology are unclear.MethodsUsing five independent models, we compared digital screening strategies starting at age 40 or 50 years applied annually, biennially, or based on density with biennial film screening from ages 50 to 74 years and with no screening. Common data elements included cancer incidence and test performance, both modified by breast density. Lifetime outcomes included mortality, quality-adjusted life-years, and screening and treatment costs.ResultsFor every 1000 women screened biennially from age 50 to 74 years, switching to digital from film yielded a median within-model improvement of 2 life-years, 0.27 additional deaths averted, 220 additional false-positive results, and $0.35 million more in costs. For an individual woman, this translates to a health gain of 0.73 days. Extending biennial digital screening to women ages 40 to 49 years was cost-effective, although results were sensitive to quality-of-life decrements related to screening and false positives. Targeting annual screening by density yielded similar outcomes to targeting by age. Annual screening approaches could increase costs to $5.26 million per 1000 women, in part because of higher numbers of screens and false positives, and were not efficient or cost-effective.ConclusionsThe transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women's preferences regarding false positives.© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

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