Cumulative Probability of False-Positive Results After 10 Years of Screening With Digital Breast Tomosynthesis vs Digital Mammography

Ho, Thao-Quyen H.; Bissell, Michael C. S.; Kerlikowske, Karla; Hubbard, Rebecca A.; Sprague, Brian L.; Lee, Christoph I.; Tice, Jeffrey A.; Miglioretti, Diana L.

doi:10.1001/jamanetworkopen.2022.2440

Cited by 37 publications

(46 citation statements)

References 38 publications

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…These risk estimates can be used by policy makers in conjunction with estimates of other breast cancer screening outcomes (such as cumulative risk of false-positive mammography results and advanced cancer) when evaluating the balance of screening benefits and harms by screening interval. 15,16 Ductal carcinoma in situ currently makes up more than 30% of screen-detected breast cancer in the US. 27 Although the goal of breast cancer screening is early detection, screening…”

Section: Discussionmentioning

confidence: 99%

“…Our findings can be used by policy makers assessing the balance of benefits and harms of different screening strategies, in conjunction with existing risk models for other screening outcomes, such as advanced cancers and false-positive mammography results. 15,16 Funding/Support: This work was supported by grant P01CA154292 from the National Institutes of Health. Data collection for this research was additionally supported by the BCSC with funding from grant U54CA163303 from the National Cancer Institute, Patient-Centered Outcomes Research Institute (PCORI) Program Award PCS-1504-30370, and grant R01 HS018366-01A1 from the Agency for Healthcare Research and Quality.…”

Section: Discussionmentioning

confidence: 99%

“…Models were recently published for cumulative 6-year risk of advanced (prognostic stage II or higher) breast cancer and cumulative 10-year risk of a false-positive mammography result based on mammography screening frequency and readily available clinical risk factors. 15 , 16 Prediction models for screen-detected DCIS would further inform screening decisions and guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Cumulative 6-Year Risk of Screen-Detected Ductal Carcinoma In Situ by Screening Frequency

et al. 2023

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ImportanceDetection of ductal carcinoma in situ (DCIS) by mammography screening is a controversial outcome with potential benefits and harms. The association of mammography screening interval and woman’s risk factors with the likelihood of DCIS detection after multiple screening rounds is poorly understood.ObjectiveTo develop a 6-year risk prediction model for screen-detected DCIS according to mammography screening interval and women’s risk factors.Design, Setting, and ParticipantsThis Breast Cancer Surveillance Consortium cohort study assessed women aged 40 to 74 years undergoing mammography screening (digital mammography or digital breast tomosynthesis) from January 1, 2005, to December 31, 2020, at breast imaging facilities within 6 geographically diverse registries of the consortium. Data were analyzed between February and June 2022.ExposuresScreening interval (annual, biennial, or triennial), age, menopausal status, race and ethnicity, family history of breast cancer, benign breast biopsy history, breast density, body mass index, age at first birth, and false-positive mammography history.Main Outcomes and MeasuresScreen-detected DCIS defined as a DCIS diagnosis within 12 months after a positive screening mammography result, with no concurrent invasive disease.ResultsA total of 916 931 women (median [IQR] age at baseline, 54 [46-62] years; 12% Asian, 9% Black, 5% Hispanic/Latina, 69% White, 2% other or multiple races, and 4% missing) met the eligibility criteria, with 3757 screen-detected DCIS diagnoses. Screening round–specific risk estimates from multivariable logistic regression were well calibrated (expected-observed ratio, 1.00; 95% CI, 0.97-1.03) with a cross-validated area under the receiver operating characteristic curve of 0.639 (95% CI, 0.630-0.648). Cumulative 6-year risk of screen-detected DCIS estimated from screening round–specific risk estimates, accounting for competing risks of death and invasive cancer, varied widely by all included risk factors. Cumulative 6-year screen-detected DCIS risk increased with age and shorter screening interval. Among women aged 40 to 49 years, the mean 6-year screen-detected DCIS risk was 0.30% (IQR, 0.21%-0.37%) for annual screening, 0.21% (IQR, 0.14%-0.26%) for biennial screening, and 0.17% (IQR, 0.12%-0.22%) for triennial screening. Among women aged 70 to 74 years, the mean cumulative risks were 0.58% (IQR, 0.41%-0.69%) after 6 annual screens, 0.40% (IQR, 0.28%-0.48%) for 3 biennial screens, and 0.33% (IQR, 0.23%-0.39%) after 2 triennial screens.Conclusions and RelevanceIn this cohort study, 6-year screen-detected DCIS risk was higher with annual screening compared with biennial or triennial screening intervals. Estimates from the prediction model, along with risk estimates of other screening benefits and harms, could help inform policy makers’ discussions of screening strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cumulative 6-Year Risk of Screen-Detected Ductal Carcinoma In Situ by Screening Frequency

et al. 2023

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Screening for Breast Cancer

Henderson,

Webber,

Weyrich

et al. 2024

JAMA

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ImportanceBreast cancer is a leading cause of cancer mortality for US women. Trials have established that screening mammography can reduce mortality risk, but optimal screening ages, intervals, and modalities for population screening guidelines remain unclear.ObjectiveTo review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force.Data SourcesMEDLINE, Cochrane Library through August 22, 2022; literature surveillance through March 2024.Study SelectionEnglish-language publications; randomized clinical trials and nonrandomized studies comparing screening strategies; expanded criteria for screening harms.Data Extraction and SynthesisTwo reviewers independently assessed study eligibility and quality; data extracted from fair- and good-quality studies.Main Outcomes and MeasuresMortality, morbidity, progression to advanced cancer, interval cancers, screening harms.ResultsSeven randomized clinical trials and 13 nonrandomized studies were included; 2 nonrandomized studies reported mortality outcomes. A nonrandomized trial emulation study estimated no mortality difference for screening beyond age 74 years (adjusted hazard ratio, 1.00 [95% CI, 0.83 to 1.19]). Advanced cancer detection did not differ following annual or biennial screening intervals in a nonrandomized study. Three trials compared digital breast tomosynthesis (DBT) mammography screening with digital mammography alone. With DBT, more invasive cancers were detected at the first screening round than with digital mammography, but there were no statistically significant differences in interval cancers (pooled relative risk, 0.87 [95% CI, 0.64-1.17]; 3 studies [n = 130 196]; I2 = 0%). Risk of advanced cancer (stage II or higher) at the subsequent screening round was not statistically significant for DBT vs digital mammography in the individual trials. Limited evidence from trials and nonrandomized studies suggested lower recall rates with DBT. An RCT randomizing individuals with dense breasts to invitations for supplemental screening with magnetic resonance imaging reported reduced interval cancer risk (relative risk, 0.47 [95% CI, 0.29-0.77]) and additional false-positive recalls and biopsy results with the intervention; no longer-term advanced breast cancer incidence or morbidity and mortality outcomes were available. One RCT and 1 nonrandomized study of supplemental ultrasound screening reported additional false-positives and no differences in interval cancers.Conclusions and RelevanceEvidence comparing the effectiveness of different breast cancer screening strategies is inconclusive because key studies have not yet been completed and few studies have reported the stage shift or mortality outcomes necessary to assess relative benefits.

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Screening for Breast Cancer

Nicholson,

Silverstein,

Wong

et al. 2024

JAMA

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ImportanceAmong all US women, breast cancer is the second most common cancer and the second most common cause of cancer death. In 2023, an estimated 43 170 women died of breast cancer. Non-Hispanic White women have the highest incidence of breast cancer and non-Hispanic Black women have the highest mortality rate.ObjectiveThe USPSTF commissioned a systematic review to evaluate the comparative effectiveness of different mammography-based breast cancer screening strategies by age to start and stop screening, screening interval, modality, use of supplemental imaging, or personalization of screening for breast cancer on the incidence of and progression to advanced breast cancer, breast cancer morbidity, and breast cancer–specific or all-cause mortality, and collaborative modeling studies to complement the evidence from the review.PopulationCisgender women and all other persons assigned female at birth aged 40 years or older at average risk of breast cancer.Evidence AssessmentThe USPSTF concludes with moderate certainty that biennial screening mammography in women aged 40 to 74 years has a moderate net benefit. The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of screening mammography in women 75 years or older and the balance of benefits and harms of supplemental screening for breast cancer with breast ultrasound or magnetic resonance imaging (MRI), regardless of breast density.RecommendationThe USPSTF recommends biennial screening mammography for women aged 40 to 74 years. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of supplemental screening for breast cancer using breast ultrasonography or MRI in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement)

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Cumulative Probability of False-Positive Results After 10 Years of Screening With Digital Breast Tomosynthesis vs Digital Mammography

Cited by 37 publications

References 38 publications

Cumulative 6-Year Risk of Screen-Detected Ductal Carcinoma In Situ by Screening Frequency

Cumulative 6-Year Risk of Screen-Detected Ductal Carcinoma In Situ by Screening Frequency

Screening for Breast Cancer

Screening for Breast Cancer

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