• 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, and Harry J de Koning.
• Department of Public Health, Erasmus MC, University Medical Center, Rotterdam. Electronic address: n.vanravesteyn@erasmusmc.nl.
• Am J Prev Med. 2015 May 1; 48 (5): 535542535-42.

IntroductionThe 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.MethodsNBCCEDP 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.ResultsThe 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.ConclusionsDigital 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.Copyright © 2015 American Journal of Preventive Medicine. All rights reserved.

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