All of the randomized controlled trials addressing the effectiveness of screening used film mammography, and there is no direct evidence that digital mammography reduces breast cancer–related deaths. Nevertheless, digital mammography has replaced film as the primary screening modality in the United States. In addition to facilitating remote reading and more efficient storage, the real advantage of digital image collection over film systems is higher contrast resolution and the ability to post-process the image to enlarge it or change contrast and brightness, helping radiologists more easily detect subtle abnormalities, particularly in a background of dense breast tissue. Most studies that have compared the performance of digital and film mammography have found little difference in cancer detection rates.
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