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. 2023 Jun;307(5):e223142.
doi: 10.1148/radiol.223142.

Digital Breast Tomosynthesis versus Digital Mammography Screening Performance on Successive Screening Rounds from the Breast Cancer Surveillance Consortium

Brian L Sprague  1 , Rebecca Yates Coley  1 , Kathryn P Lowry  1 , Karla Kerlikowske  1 , Louise M Henderson  1 , Yu-Ru Su  1 , Christoph I Lee  1 , Tracy Onega  1 , Erin J A Bowles  1 , Sally D Herschorn  1 , Roberta M diFlorio-Alexander  1 , Diana L Miglioretti  1
Affiliations

Digital Breast Tomosynthesis versus Digital Mammography Screening Performance on Successive Screening Rounds from the Breast Cancer Surveillance Consortium

Brian L Sprague et al. Radiology. 2023 Jun.

Abstract

Background Prior cross-sectional studies have observed that breast cancer screening with digital breast tomosynthesis (DBT) has a lower recall rate and higher cancer detection rate compared with digital mammography (DM). Purpose To evaluate breast cancer screening outcomes with DBT versus DM on successive screening rounds. Materials and Methods In this retrospective cohort study, data from 58 breast imaging facilities in the Breast Cancer Surveillance Consortium were collected. Analysis included women aged 40-79 years undergoing DBT or DM screening from 2011 to 2020. Absolute differences in screening outcomes by modality and screening round were estimated during the study period by using generalized estimating equations with marginal standardization to adjust for differences in women's risk characteristics across modality and round. Results A total of 523 485 DBT examinations (mean age of women, 58.7 years ± 9.7 [SD]) and 1 008 123 DM examinations (mean age, 58.4 years ± 9.8) among 504 863 women were evaluated. DBT and DM recall rates decreased with successive screening round, but absolute recall rates in each round were significantly lower with DBT versus DM (round 1 difference, -3.3% [95% CI: -4.6, -2.1] [P < .001]; round 2 difference, -1.8% [95% CI: -2.9, -0.7] [P = .003]; round 3 or above difference, -1.2% [95% CI: -2.4, -0.1] [P = .03]). DBT had significantly higher cancer detection (difference, 0.6 per 1000 examinations [95% CI: 0.2, 1.1]; P = .009) compared with DM only for round 3 and above. There were no significant differences in interval cancer rate (round 1 difference, 0.00 per 1000 examinations [95% CI: -0.24, 0.30] [P = .96]; round 2 or above difference, 0.04 [95% CI: -0.19, 0.31] [P = .76]) or total advanced cancer rate (round 1 difference, 0.00 per 1000 examinations [95% CI: -0.15, 0.19] [P = .94]; round 2 or above difference, -0.06 [95% CI: -0.18, 0.11] [P = .43]). Conclusion DBT had lower recall rates and could help detect more cancers than DM across three screening rounds, with no difference in interval or advanced cancer rates. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Skaane in this issue.

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Conflict of interest statement

Disclosures of conflicts of interest: B.L.S. Grants and contracts paid to institution from the American College of Radiology and the National Cancer Institute (NCI). R.Y.C. Co-investigator on grants from the National Institute of Mental Health (NIMH), National Institute on Aging (NIA), NCI, Agency for Healthcare Research and Quality, and Patient-Centered Outcomes Research Institute (PCORI); co-investigator on contract with the Food and Drug Administration; principal investigator on grant from the NIMH; honoraria from the University of Washington and the American Statistical Association (ASA); payment for grant review from PCORI; support to attend conference from ASA; communications committee chair of the ASA JEDI Outreach Group. K.P.L. Grant from the American Cancer Society. K.K. No relevant relationships. L.M.H. No relevant relationships. Y.R.S. Grants to institution from the NIA, Syneos Health, and the University of Washington. C.I.L. Textbook royalties from McGraw Hill, Oxford University Press, and UpToDate; personal fees for participation on a data safety monitoring board or advisory board for Grail; personal fees for journal editorial board work from the American College of Radiology. T.O. No relevant relationships. E.J.A.B. No relevant relationships. S.D.H. Participation on the medical advisory board of DenseBreast-Info.org. R.M.d.F.A. Grants from the National Institutes of Health; continuing medical education funds from department; membership on the American College of Radiology Appropriateness Criteria Committee (2015–2020). D.L.M. No relevant relationships.

Figures

None
Graphical abstract
Study flow diagram. BCSC = Breast Cancer Surveillance Consortium, DBT = digital breast tomosynthesis, DM = digital mammography.
Figure 1:
Study flow diagram. BCSC = Breast Cancer Surveillance Consortium, DBT = digital breast tomosynthesis, DM = digital mammography.
Example images from three successive rounds of digital breast tomosynthesis. Right craniocaudal tomosynthesis section in a 66-year-old woman screened in (A) 2020, (B) 2021, and (C) 2022 with a new area of architectural distortion identified in 2022 (arrow), which led to a cancer diagnosis.
Figure 2:
Example images from three successive rounds of digital breast tomosynthesis. Right craniocaudal tomosynthesis section in a 66-year-old woman screened in (A) 2020, (B) 2021, and (C) 2022 with a new area of architectural distortion identified in 2022 (arrow), which led to a cancer diagnosis.
Example images from three successive rounds of digital mammography screening. Left mediolateral oblique (LMLO) view in a 64-year-old woman screened in (A) 2014, (B) 2015, and (C) 2016 with a new irregular mass identified in 2016 (arrow), which led to a cancer diagnosis. MLO = mediolateral oblique.
Figure 3:
Example images from three successive rounds of digital mammography screening. Left mediolateral oblique (LMLO) view in a 64-year-old woman screened in (A) 2014, (B) 2015, and (C) 2016 with a new irregular mass identified in 2016 (arrow), which led to a cancer diagnosis. MLO = mediolateral oblique.
See this image and copyright information in PMC

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