Comparison of interval breast cancers with 2D digital mammography versus 3D digital breast tomosynthesis in a large community‐based practice

Abstract

Incidence of interval cancers is an important outcome in assessing efficacy of screening. Our primary objective was to compare the incidence of interval cancers detected with two‐dimensional digital mammography (DM) versus digital breast tomosynthesis (DBT) in a large community health system. Our secondary objectives were to compare the patient and tumor characteristics of interval cancers, cancer detection rate, and recall rate. Interval cancers before and after implementation of DBT (2012‐2014 DM group; 2016‐2018 DBT group) were reviewed. Patient factors (age, race, breast density, personal history of breast cancer, family history of breast cancer, known BRCA‐1 or BRCA‐2 genetic mutation, baseline mammogram, and presentation) and tumor characteristics (in situ versus invasive, grade, size, hormone receptor status, and nodal status) were compared with the chi‐squared test or the MidP exact test. Rates (detection and recall) were compared using a z‐score. The rates of interval cancers with DM (0.30 per 1000 [35/117 099]) and DBT (0.33 per 1000 [40/119 746]) were similar (P = .3). Proportion of node‐positive interval cancers was lower in the DBT group (22.9% [8/35] vs 48% [15/31], p.01). Otherwise, the patient and tumor characteristics were similar. The cancer detection rate increased (5.9 per 1000 [709/119 746] vs 3.5 per 1000 [411/117 099], P = .0001), and the recall rate decreased with DBT (8.6% [10 347/119 746] versus 10.7% [12 508/117 099], (P < .0001). Although the cancer detection rate was higher with DBT, the rate of interval breast cancers was similar in both groups. Node‐positive invasive interval cancers were decreased with DBT.

True and Missed Interval Cancer in Organized Mammographic Screening: A Retrospective Review Study of Diagnostic and Prior Screening Mammograms

“…Our finding of no statistically significant difference in interval cancer rate between screening with DBT+SM versus DM is in keeping with most other studies(104,157,159,160,(162)(163)(164). One exception is MBTST, in which a statistically significant lower interval cancer rate for women screened with DBT compared with a historical cohort screened with…”

“…cancer detected after screening with DBT+SM versus DM. Few other studies report on histopathological tumor characteristics for interval cancer after screening with DBT, and those who do are mainly in line with our study(104,160,161,163).One major challenge concerning interval cancer and DBT is that interval cancer rates in general are low, which require larger study populations than what is published to reach statistical significance at the observed rates. Due to our large study sample and almost 100% completeness of the database at the Cancer Registry of Norway on interval cancer, our study has one of the highest number of interval cancers (n=156) among the published studies.…”

“…When an increase in cancer detection at screening is observed, a decrease in interval cancer rate is anticipated. To date, among the few studies reporting interval cancer rates after screening with DBT+DM/SM, only MBTST has demonstrated a statistically significant interval cancer reduction, otherwise no statistically significant differences were observed (Table 1.6) (104,157,(159)(160)(161)(162)(163)(164)(165) . A recent meta-analysis of five European studies demonstrated a pooled difference in interval cancer rates for DBT versus DM of -0.15/1000 (95% CI -0.59 -0.29) (166).…”

Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis

“…For improved interpretation of the increased CDR, cancer biology and results for different breast densities may play a role. While Winter et al [ 36 ] reported a lower rate of node positive interval cancers after DBT screening, Bahl et al [ 37 ] reported comparable biology of interval cancer after DBT versus FFDM. Both of these study designs, however, cannot exclude bias.…”

Meta-analysis of diagnostic cell-free circulating microRNAs for breast cancer detection

“…Nevertheless, mammography and ultrasonography do have some drawbacks in detecting early-stage BC, such as lower sensitivity in younger women or in women with higher breast density [ 3 , 4 ]. In addition, mammography screens are planned at fixed time intervals, but non-predicted interval cancers may occur between two screens [ 5 ]. Moreover, experienced radiologists are required to analyse mammography results [ 4 ] as well as to carry out MRI scans, which are also very time-consuming, costly and impractical to be performed routinely.…”