Two-modality mammography may confer an advantage over either full-field digital mammography or screen-film mammography

Rationale and Objectives. We sought to compare the cancer detection rate and receiver operating characteristic (ROC) area under the curve of full-field digital mammography, screen-film mammography, and a combined technique that allowed diagnosis if a finding was suspicious on film mammography, on digital mammography, or both. Materials and Methods. We used the data originally analyzed by Lewin and associates in 2002. In that trial, 6,736 paired full-field and digital mammograms were performed in 4,489 women. We used parametric and nonparametric tests to compare the area under the curve for ROC scores of film-screen only, digital mammography only, and the combined test. We used McNemar's test for paired proportions to compare the cancer detection rates. Results. With the parametric test, neither the difference in the area under the curve between the film and combined nor the difference between the digital and combined ROC curves was significant at the Bonferroni-corrected 0.025 a level (film versus combined difference = 0.0563, P = .0712; digital versus combined difference = 0.0894, P = .0455). The nonparametric test showed that there was a significant difference between both film and combined (difference = 0.073, P = .008) and digital versus combined ROC curves (difference = 0.1164, P = .0008). The continuity-corrected McNemar's test showed a significant increase in the proportion of cancers detected by the combined modality over film (chi(2) 7.111, df = 1, P = .0077), and over digital (chi(2) = 12.071, df = 1, P = .0005). Conclusion. Using two mammograms, one film and one digital, significantly increases the detection of breast cancer.