Journal of Medical Screening > Volume 15, Number 1 > Pp. 23-26

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Original Articles

Performance of systematic and non-systematic (‘opportunistic’) screening mammography: a comparative study from Denmark

Kristine Bihrmann, Statistician  , Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark

Allan Jensen, Post Doc , Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark

Anne Helene Olsen, Post Doc , Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark

Sisse Njor, Statistician , Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark

Walter Schwartz, Chief Physician , Mammography Screening Clinic, University Hospital Odense, Odense, Denmark

Ilse Vejborg, Chief Physician , Centre of Diagnostic Imaging, University Hospital Copenhagen, Copenhagen Ø, Denmark

Elsebeth Lynge, Professor , Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark

Correspondence to: Kristine Bihrmann, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, opg B, PO Box 2099 1014 Copenhagen K, Denmark; k.bihrmann{at}pubhealth.ku.dk

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Objectives Evaluation and comparison of the performance of organized and opportunistic screening mammography.

Methods Women attending screening mammography in Denmark in 2000. The study included 37,072 women attending organized screening. Among these, 320 women were diagnosed with breast cancer during follow-up. Opportunistic screening was attended by 2855 women with 26 women being diagnosed with breast cancer. Data on women attending screening were linked with information on cancer status. Each woman was followed with respect to diagnosis of breast cancer (invasive as well as in situ) for a period of two years. Screening outcome and cancer status during follow-up were combined to assess whether the result of the examination was true-positive, true-negative, false-positive or false-negative. Based on this classification, age-adjusted sensitivity and specificity of organized and opportunistic screening were calculated.

Results Defining BI-RADS^TM 4–5 as a positive screening outcome, the overall sensitivity of opportunistic screening was 33.6% and the specificity was 99.1%. Using BI-RADS^TM 3–5 as positive, the sensitivity was 37.4% and the specificity was 97.9%. Organized screening (which was not categorized according to BI-RADS^TM) had an overall sensitivity of 67.2% and a specificity of 98.4%.

Conclusion Our study showed a considerably higher sensitivity in organized screening than in opportunistic screening, while the specificity was fairly similar in the two settings. The findings support implementation of population-based breast screening programmes, as recommended in the ‘European guidelines for quality assurance in breast cancer screening and diagnosis’.

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