Digital Mammography
Menée aux Etats-Unis à l'aide de cinq modèles mathématiques, cette étude estime, en fonction de différentes stratégies de dépistage du cancer du sein, le rapport coût-efficacité de la mammographie numérique par rapport à la mammographie analogique
Currently in the United States, digital mammography has almost completely replaced film-screen mammography, although it was recognized early that specificity was reduced (the numbers of normal results deemed falsely positive to the test increased) even though the sensitivity of the test was increased (the number of women found positive to the test of those who truly had the disease) (1). However, increased sensitivity in detecting disease is not necessarily accompanied by the benefit sought (ie, reduced numbers of deaths from breast cancer in screened women). Using five mathematical models from the CISNET consortium, Stout et al. in this issue of the Journal address this important issue (2). All of the models used identical data as input. Although the approaches used to model the natural history of breast cancer were different in the four models that attempted this, the fifth model begins at cancer detection and does not explicitly capture natural history. Medians were derived from the results of the different models in making the final estimates. The fact that the conclusions were derived from the application of five models makes them far more robust than if only a single model were used. This is one of the major strengths of the CISNET consortium. However, Supplementary Table 3 in Stout et al...