Objectives: To estimate detection measures for tomosynthesis and standard mammography; to assess the feasibility of using tomosynthesis in population-based screening for breast cancer.Design, setting: Prospective pilot trial comparing tomosynthesis (with synthesised 2D images) and standard mammography screening of women attending Maroondah BreastScreen, a BreastScreen Victoria service in the eastern suburbs of Melbourne.Participants: Women at least 40 years of age who presented for routine breast screening between 18 August 2017 and 8 November 2018. Main outcome measures:Cancer detection rate (CDR); proportion of screens that led to recall for further assessment.Results: 5018 tomosynthesis and 5166 standard mammography screens were undertaken in 10 146 women; 508 women (5.0% of screens) opted not to undergo tomosynthesis screening. With tomosynthesis, 49 cancers (40 invasive, 9 in situ) were detected (CDR, 9.8 [95% CI, 7.2-13] per 1000 screens); with standard mammography, 34 cancers (30 invasive, 4 in situ) were detected (CDR, 6.6 [95% CI, 4.6-9.2] per 1000 screens). The estimated difference in CDR was 3.2 more detections (95% CI, -0.32 to 6.8) per 1000 screens with tomosynthesis; the difference was greater for repeat screens and for women aged 60 years or more. The recall rate was greater for tomosynthesis (4.2%; 95% CI, 3.6-4.8%) than standard mammography (3.0%; 95% CI, 2.6-3.5%; estimated difference, 1.2%; 95% CI, 0.46-1.9%). The median screen reading time for tomosynthesis was 67 seconds (interquartile range [IQR] 46-105 seconds); for standard mammography, 16 seconds (IQR, 10-29 seconds). Conclusions:Breast cancer detection, recall for assessment, and screen reading time were each higher for tomosynthesis than for standard mammography. Our preliminary findings could form the basis of a large scale comparative evaluation of tomosynthesis and standard mammography for breast screening in Australia.Trial registration: Australian New Zealand Clinical Trials Registry, AC TRN12617000947303.The known: Overseas studies have found that digital breast tomosynthesis (3D mammography) can increase breast cancer detection rates and reduce the frequency of unnecessary recalls for assessment.The new: Our prospective pilot trial of population-based tomosynthesis screening in Maroondah BreastScreen found that more breast cancers were detected by tomosynthesis (9.8 [95% CI, 7.2-13] per 1000 screens) than by standard mammography (6.6 [95% CI, 4.6-9.2] per 1000 screens), but the recall rate was also higher (4.2% v 3.0%). The implications:Tomosynthesis breast screening is feasible if infrastructure and service preparation are adequate. Our findings could inform larger evaluations of tomosynthesis and standard mammography for breast screening in BreastScreen.
Introduction: Australia's first population-based pilot trial comparing digital breast tomosynthesis (DBT) and digital mammography (DM) screening reported detection measures in 2019. This study describes the trial's secondary outcomes pertaining to the assessment process in women screened with DBT or DM, including the type of recalled abnormalities and the procedures performed. Methods: Women with suspected abnormalities at screening were recalled for further investigation. Outcome measures were number of lesions assessed, types of imaging findings recalled to assessment, and data on testing and assessment outcomes; these were reported using descriptive analyses of lesion-specific data. Results: A total of 274 lesions and 203 lesions were reported in the DBTscreened and DM-screened groups, respectively. There were a higher proportion of lesions depicted as calcifications (32.4% vs 21.3%), and a lower proportion of lesions depicted as asymmetrical densities (3.2% vs 15.7%) for DBT recalls than DM recalls. A lower proportion of DBT-recalled lesions was assessed with additional mammography than DM-recalled lesions (49.3% vs 93.1%). Higher proportions of DBT-recalled lesions than DM-recalled lesions were investigated with clinical breast examination (50.4% vs 39.9%), core needle biopsy (45.6% vs 28.6%) and open biopsy (4.0% vs 1.0%). Similar proportions of DBT-and DM-recalled lesions were assessed using ultrasound (76.3% vs 71.4%). Conclusion: Assessment of screen-recalled lesions showed that, compared with DM, DBT found more benign and more malignant lesions, and generally required more procedures except for less additional mammography workup. These findings show that a transition to DBT screening changes the assessment workload.
Objectives To determine the total annual screening and further-investigation costs of investigating false-positive and true-positive mammograms in the Australian population breast-screening program. Methods This economic analysis used aggregate-level retrospective cohort data of women screened at a breast-screening clinic. Counts and frequencies of each diagnostic workup-sequence recorded were scaled up to national figures and costed by estimating per-patient costs of procedures using screening clinic cost data. Main outcomes and measures estimated were percentage share of total annual screening and further-investigation costs for the Australian population breast-screening program of investigating false-positive and true-positive mammograms. Secondary outcomes determined were average costs of investigating each false-positive and true-positive mammogram. Sensitivity analyses involved recalculating results excluding subgroups of patients below and above the screening age range of 50–74 years. Results Of 8235 patients, the median age was 60.35 years with interquartile range of 54.17–67.17 years. A total of 15.4% (ranging from 13.4 to 15.4% under different scenarios) of total annual screening and further-investigation costs were from investigating false-positive mammograms. This exceeded the share of costs from investigating true-positives (13%). Conclusions We have developed a transparent and non-onerous approach for estimating the costs of false-positive and true-positive mammograms associated with the national breast-screening program. While determining an optimal balance between false-positives and true-positive rates must rely primarily on health outcomes, costs are an important consideration. We recommend that future research adopts and refines similar approaches to facilitate better monitoring of these costs, benchmark against estimates from other screening programs, and support optimal policy development.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.