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. 2024 Aug;129(8):1156-1172.
doi: 10.1007/s11547-024-01849-0. Epub 2024 Jul 23.

Organizational impact of systemic implementation of digital breast tomosynthesis as a primary test for breast cancer screening in Italy

Olivera Djuric  1   2 , Silvia Deandrea  3 , Paola Mantellini  4 , Francesco Sardanelli  5 , Francesco Venturelli  1 , Stefania Montemezzi  6 , Riccardo Vecchio  3 , Lauro Bucchi  7 , Carlo Senore  8 , Livia Giordano  8 , Eugenio Paci  9 , Adriana Bonifacino  10 , Massimo Calabrese  11 , Francesca Caumo  12 , Flori Degrassi  13 , Priscilla Sassoli De' Bianchi  14 , Francesca Battisti  4 , Marco Zappa  4 , Pierpaolo Pattacini  1 , Cinzia Campari  1 , Andrea Nitrosi  1 , Giovanni Di Leo  5 , Alfonso Frigerio  8 , Veronica Magni  5 , Francesca Fornasa  15 , Giovanna Romanucci  15 , Patrizia Falini  4 , Noemi Auzzi  4 , Paola Armaroli  8 , Paolo Giorgi Rossi  16 ; MAITA working group; Italian Breast Cancer Screening Guidelines working group
Collaborators, Affiliations

Organizational impact of systemic implementation of digital breast tomosynthesis as a primary test for breast cancer screening in Italy

Olivera Djuric et al. Radiol Med. 2024 Aug.

Abstract

Purpose: We present a comprehensive investigation into the organizational, social, and ethical impact of implementing digital breast tomosynthesis (DBT) as a primary test for breast cancer screening in Italy. The analyses aimed to assess the feasibility of DBT specifically for all women aged 45-74, women aged 45-49 only, or those with dense breasts only.

Methods: Questions were framed according to the European Network of Health Technology Assessment (EuNetHTA) Screening Core Model to produce evidence for the resources, equity, acceptability, and feasibility domains of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) decision framework. The study integrated evidence from the literature, the MAITA DBT trials, and Italian pilot programs. Structured interviews, surveys, and systematic reviews were conducted to gather data on organizational impact, acceptability among women, reading and acquisition times, and the technical requirements of DBT in screening.

Results: Implementing DBT could significantly affect the screening program, primarily due to increased reading times and the need for additional human resources (radiologists and radiographers). Participation rates in DBT screening were similar, if not better, to those observed with standard digital mammography, indicating good acceptability among women. The study also highlighted the necessity for specific training for radiographers. The interviewed key persons unanimously considered feasible tailored screening strategies based on breast density or age, but they require effective communication with the target population.

Conclusions: An increase in radiologists' and radiographers' workload limits the feasibility of DBT screening. Tailored screening strategies may maximize the benefits of DBT while mitigating potential challenges.

Keywords: Breast neoplasms; Digital breast tomosynthesis; Digital mammography; Health technology assessment; Mass screening; Organizational impact.

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