Transition from film to digital mammography: impact for breast cancer screening through the national breast and cervical cancer early detection program.
Transition from film to digital mammography: impact for breast cancer screening through the national breast and cervical cancer early detection program.
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从胶片到数字乳房X光检查的转变：通过国家乳腺癌和宫颈癌早期检测计划对乳腺癌筛查的影响。
DOI：
10.1016/j.amepre.2014.11.010
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发表时间：
2015
影响因子：
5.5
通讯作者：
deKoning,HarryJ
中科院分区：
文献类型：
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作者：
vanRavesteyn,NicolienT;vanLier,Lisanne;Schechter,ClydeB;Ekwueme,DonatusU;Royalty,Janet;Miller,JacquelineW;Near,AimeeM;Cronin,KathleenA;Heijnsdijk,EvelineAM;Mandelblatt,JeanneS;deKoning,HarryJ
国家乳腺癌和宫颈癌早期检测计划（NBCCEDP）为40-64岁的低收入、无保险的妇女提供乳房x光检查和诊断服务。NBCCEDP内的乳房x光检查设备逐渐从普通胶片转向数字乳房x光检查。本研究的目的是评估用数字乳房x线照相术取代胶片对健康影响的影响（避免死亡，获得生命年[LYG]）；费用（筛查和诊断费用）；达到的女性人数。方法采用snbccedp 2010数据和项目目标人群代表性数据建立微观模拟模型。模型模拟了观察到的筛查行为，包括白人、黑人和西班牙裔女性的不同筛查间隔（一年、两年、不定期）和起始年龄（40岁、50岁）。2012年进行了模型运行。结果模型预测黑人女性每1000个电影屏幕的LYG为8.0-8.3，白人女性为5.9-7.5，西班牙裔女性为4.0-4.5。对于所有种族/民族，数字乳房x光检查的LYG高于胶片x光检查（2%-4%），但成本更高（34%-35%）。假设预算固定，如果所有的乳房x光检查都转换为数字检查，那么可以减少25%-26%的女性服务，从而减少22%-24%的LYG检查。仅包括两年一次的筛查，LYG的损失可以逆转为8%-13%的增加。结论数字乳房x线摄影的LYG略高于胶片x线摄影。然而，在固定预算的情况下，更少的妇女可能得到更少的LYG服务。计划的改变，例如只包括两年一次的筛查，将增加LYG/筛查，并可以抵消转向数字乳房x光检查时LYG的潜在下降。
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.