The Who, What, Where, When and Sometimes, Why.

Digital vs. film mammography screening

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table

Introduction: Mammograms are X-ray images of the breast. In the past, mammogram images were stored on film (film mammography). Now, mammogram images are usually stored on a computer (digital mammography).

Film and digital mammography are similar in their ability to find breast cancer [1-3]. However, because digital images are viewed on a computer, they can be lightened or darkened, and certain sections can be enlarged and looked at more closely. This makes digital mammography a better screening tool than film mammography for some women.

In general, digital mammography is better at finding breast cancer in women who [2]:

  • Are premenopausal or peri-menopausal  
  • Are under age 50
  • Have dense breast tissue

For women who don’t fall in one of the above groups, film and digital mammography are similar in their ability to find breast cancer early.

Learn more about mammography.

Study measures (sensitivity and specificity)

The main goal of any cancer screening test is to correctly identify everyone who has cancer (called the sensitivity of the test). For example, a sensitivity of 90 percent means 90 percent of people tested who truly have cancer are correctly identified as having cancer.

An ideal cancer screening test would also be able to correctly identify all the people who don’t have cancer as not having it (called the specificity of the test). For example, a specificity of 90 percent means 90 percent of the people who don’t have cancer are correctly identified as not having cancer.

When sensitivity is high, the test picks up even the slightest abnormal finding. Very few cases are missed, but the test will mistake some people as having cancer when they don’t (called a false positive result).

When specificity is high, there are few false positive results, but more cases of true cancer are missed.

No screening test has perfect sensitivity and perfect specificity. There’s always a trade-off between the two. That is, when a test gains sensitivity, it loses some specificity.

Learn more about the quality of screening tests.

Study selection criteria: Clinical trials that included at least 1,000 mammograms.

Table note: The studies below compare the sensitivity and specificity for film and digital mammography.

There are no data comparing survival for women who had screening with film mammography versus those who had screening with digital mammography.

Study

Study Population
(number of participants)

Sensitivity

Specificity

Film Mammography

Digital Mammography

Film Mammography

Digital Mammography

Randomized clinical trials

Skaane et al. (Oslo II Study) [1]

23,929

62%NS

77%NS

98%SIG

97%SIG

Clinical trials

Pisano et al. (DMIST) [2,3]

42,760

66%NS

70%NS

92%NS

92%NS

 

Among women younger than 50 with dense breast tissue

27%SIG

59%SIG

89%NS

90%NS

 

Among women younger than 50 with non-dense breast tissue

 NS 

NS 

 NS  

 NS 

 

Among women 50 years or older with dense breast tissue

 NS 

 NS 

 NS 

 NS 

 

Among women 50 years or older with non-dense breast tissue

 NS 

 NS 

 NS 

 NS 

Lewin et al. [4]

4,945

63%NS

60%NS

N/A

N/A

NS = No statistically significant difference between film and digital mammography

SIG = Statistically significant difference between film and digital mammography

N/A = Results not available

References

1. Skaane P, Hofvind S, Skjennald A. Randomized trial of screen-film versus full-field digital mammography with soft-copy reading in population-based screening program: follow-up and final results of Oslo II study. Radiology. 244(3):708-17, 2007.

2. Pisano ED, Gatsonis C, Hendrick E, et al. for the Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med. 353(17):1773-83, 2005.

3. Pisano ED, Hendrick RE, Yaffe MJ, et al. for the Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group. Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology. 246(2):376-83, 2008.

4. Lewin JM, Hendrick RE, D’Orsi CJ, et al. Comparison of full-field digital mammography with screen-film mammography for cancer detection: results of 4,945 paired examinations. Radiology. 218(3):873-80, 2001.

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