Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 May 1;5(5):635-642.
doi: 10.1001/jamaoncol.2018.7078.

Association of Digital Breast Tomosynthesis vs Digital Mammography With Cancer Detection and Recall Rates by Age and Breast Density

Emily F Conant  1 , William E Barlow  2 , Sally D Herschorn  3   4 , Donald L Weaver  4   5 , Elisabeth F Beaber  6 , Anna N A Tosteson  7   8   9 , Jennifer S Haas  10 , Kathryn P Lowry  11 , Natasha K Stout  12 , Amy Trentham-Dietz  13 , Roberta M diFlorio-Alexander  14 , Christopher I Li  15 , Mitchell D Schnall  1 , Tracy Onega  9   16   17   18 , Brian L Sprague  3   4   19 ; Population-based Research Optimizing Screening Through Personalized Regimen (PROSPR) Consortium
Affiliations
Comparative Study

Association of Digital Breast Tomosynthesis vs Digital Mammography With Cancer Detection and Recall Rates by Age and Breast Density

Emily F Conant et al. JAMA Oncol. .

Abstract

Importance: Breast cancer screening examinations using digital breast tomosynthesis (DBT) has been shown to be associated with decreased false-positive test results and increased breast cancer detection compared with digital mammography (DM). Little is known regarding the size and stage of breast cancer types detected and their association with age and breast density.

Objective: To determine whether screening examinations using DBT detect breast cancers that are associated with an improved prognosis and to compare the detection rates by patient age and breast density.

Design, setting, and participants: This retrospective analysis of prospective cohort data from 3 research centers in the Population-based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium included data of women aged 40 to 74 years who underwent screening examinations using DM and DBT from January 1, 2011, through September 30, 2014. Statistical analysis was performed from November 8, 2017, to August 14, 2018.

Exposures: Use of DBT as a supplement to DM at breast cancer screening examination.

Main outcomes and measures: Recall rate, cancer detection rate, positive predictive value, biopsy rate, and distribution of invasive cancer subtypes.

Results: Among 96 269 women (mean [SD] patient age for all examinations, 55.9 [9.0] years), patient age was 56.4 (9.0) years for DM and 54.6 (8.9) years for DBT. Of 180 340 breast cancer screening examinations, 129 369 examinations (71.7%) used DM and 50 971 examinations (28.3%) used DBT. Screening examination with DBT (73 of 99 women [73.7%]) was associated with the detection of smaller, more often node-negative, HER2-negative, invasive cancers compared with DM (276 of 422 women [65.4%]). Screening examination with DBT was also associated with lower recall (odds ratio, 0.64; 95% CI, 0.57-0.72; P < .001) and higher cancer detection (odds ratio, 1.41; 95% CI, 1.05-1.89; P = .02) compared with DM for all age groups even when stratified by breast density. The largest increase in cancer detection rate and the greatest shift toward smaller, node-negative invasive cancers detected with DBT was for women aged 40 to 49 years. For women aged 40 to 49 years with nondense breasts, the cancer detection rate for examinations using DBT was 1.70 per 1000 women higher compared with the rate using DM; for women with dense breasts, the cancer detection rate was 2.27 per 1000 women higher for DBT. For these younger women, screening with DBT was associated with only 7 of 28 breast cancers (25.0%) categorized as poor prognosis compared with 19 of 47 breast cancers (40.4%) when screening with DM.

Conclusions and relevance: The findings suggest that screening with DBT is associated with increased specificity and an increased proportion of breast cancers detected with better prognosis compared with DM. In the subgroup of women aged 40 to 49 years, routine DBT screening may have a favorable risk-benefit ratio.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Conant reported grants from the National Cancer Institute during the conduct of the study, a grant from iCAD, Inc outside the submitted work, and grants from Hologic, Inc and consulting and speaker’s bureau fees outside the submitted work. Dr Barlow reported grants from the National Cancer Institute during the conduct of the study. Dr Herschorn reported grants from the National Institutes of Health during the conduct of the study. Dr Weaver reported grants from the National Institutes of Health and the National Cancer Institute during the conduct of the study. Dr Beaber reported grants from the National Cancer Institute during the conduct of the study. Dr Tosteson reported grants from the National Cancer Institute during the conduct of the study. Dr Haas reported grants from the National Cancer Institute during the conduct of the study. Dr Lowry reported affiliation with the Association of University Radiologists–General Electric outside the submitted work and receiving the Association of University Radiologists–General Electric Radiology Research Academic Fellowship. Dr Li reported association with the Fred Hutchinson Cancer Center. Dr Onega reported grants from the National Cancer Institute during the conduct of the study. Dr Sprague reported grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Comparison of Recalls and Cancer Detection Rates Between Digital Mammography and Digital Breast Tomosynthesis Overall and for Nondense Breasts and Dense Breasts by Age Group and Modality
See this image and copyright information in PMC

Comment in

References

    1. Houssami N, Miglioretti DL. Digital breast tomosynthesis: a brave new world of mammography screening. JAMA Oncol. 2016;2(6):725-727. doi: 10.1001/jamaoncol.2015.5569 - DOI - PubMed
    1. Marinovich ML, Hunter KE, Macaskill P, Houssami N. Breast cancer screening using tomosynthesis or mammography: a meta-analysis of cancer detection and recall. J Natl Cancer Inst. 2018;110(9):942-949. doi: 10.1093/jnci/djy121 - DOI - PubMed
    1. Ciatto S, Houssami N, Bernardi D, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol. 2013;14(7):583-589. doi: 10.1016/S1470-2045(13)70134-7 - DOI - PubMed
    1. Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 2013;267(1):47-56. doi: 10.1148/radiol.12121373 - DOI - PubMed
    1. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014;311(24):2499-2507. doi: 10.1001/jama.2014.6095 - DOI - PubMed

Publication types