Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography

McDonald, Elizabeth S.; Oustimov, Andrew; Weinstein, Susan P.; Synnestvedt, Marie; Schnall, Mitchell D.; Conant, Emily F.

doi:10.1001/jamaoncol.2015.5536

Cited by 194 publications

(129 citation statements)

References 28 publications

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“…If the interval cancer rate remains unchanged then it could be argued that screening DBT is predominantly increasing overdiagnosis and is unlikely to impact on breast cancer mortality. A recent US study has shown a trend towards a lower interval cancer rate following the introduction of tomosynthesis screening (17).…”

Section: Tomosynthesis and Overdiagnosismentioning

confidence: 99%

Overdiagnosis in breast imaging

Evans

Vinnicombe

2017

The Breast

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The main harm of overdiagnosis is overtreatment. However a form of overdiagnosis also occurs when foci of cancer are found by imaging in addition to the symptomatic lesion when this leads to additional treatment which does not benefit the patient. Even if overtreatment is avoided, knowledge of the diagnosis can still cause psychological harm.Overdiagnosis is an inevitable effect of mammographic screening as the benefit comes from diagnosing breast cancer prior to clinical detectability. Estimates of the rate of overdiagnosis at screening are around 10%. DCIS represents 20% of cancers detected by screening and is the main focus in the overdiagnosis debate. Detection and treatment of low grade DCIS and invasive tubular cancer would appear to represent overdiagnosis in most cases. Supplementary screening with tomosynthesis or US are both likely to increase overdiagnosis as both modalities detect predominantly low grade invasive cancers. MRI causes overdiagnosis because it is so sensitive that it detects real tumour foci which after radiotherapy and systemic therapy do not, in many cases go on and cause local recurrence if the women had had no MRI and undergone breast conservation and adjuvant therapy with these small foci left in situ.

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Section: Tomosynthesis and Overdiagnosismentioning

confidence: 99%

Overdiagnosis in breast imaging

Evans

Vinnicombe

2017

The Breast

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“…In one study [42], over a 3-year period DBT recall rates at the population level remained statistically significantly lower than those for digital mammography alone, with recall rates of 88, 90, and 92 cancers per 1000 women screened for the first 3 years of DBT, respectively, versus a recall rate of 104 recalls per 1000 women screened with FFDM alone. A nonsignificant trend of increasing cancer detection rate over time was noted, from 5.5 at the prevalence screening examination to 6.1 cancers per 1000 women in year 3 of DBT [42]. A prospective trial conducted within a European screening program [43] reported a significantly increased cancer detection rate for women screened with both FFDM and DBT compared with FFDM alone (6.3 vs 8.5 cancers per 1000 women, respectively).…”

Section: Synopsis and Synthesis Of Evidencementioning

confidence: 99%

Imaging Surveillance After Primary Breast Cancer Treatment

Lam

Houssami

Lee

2017

American Journal of Roentgenology

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OBJECTIVE Current clinical guidelines are consistent in supporting annual mammography for women after treatment of primary breast cancer. Surveillance imaging beyond standard digital mammography, including digital breast tomosynthesis (DBT), breast ultrasound, and MRI, may improve outcomes. This article reviews the evidence on the performance and effectiveness of breast imaging modalities available for surveillance after treatment of sporadic unilateral primary breast cancer and identifies additional factors to be considered when selecting an imaging surveillance regimen. CONCLUSION Evidence review supports the use of mammography for surveillance after primary breast cancer treatment. Variability exists in guideline recommendations for surveillance initiation, interval, and cessation. DBT offers the most promise as a potential modality to replace standard digital mammography as a front-line surveillance test; a single published study to date has shown a significant decrease in recall rates compared with standard digital mammography alone. Most guidelines do not support the use of whole-breast ultrasound in breast cancer surveillance, and further studies are needed to define the characteristics of women who may benefit from MRI surveillance. The emerging evidence about surveillance imaging outcomes suggests that additional factors, including patient and imaging characteristics, tumor biology and gene expression profile, and choice of treatment, warrant consideration in selecting personalized posttreatment imaging surveillance regimens.

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“…This cautiousness is due to the need to avoid an increase in overdiagnosis and costs. First results for a reduction from 0.7 to 0.5 interval cancers per 100 screened women were recently reported from a large study in the US [29], but further evidence is needed.Note H. During a breast examination performed outside the screening setting, it is the choice of the radiologist whether to perform only mammography, to associate tomosynthesis and/or ultrasound, or also to perform tomosynthesis without standard mammography and to obtain reconstructed synthetic mammograms. This decision is based on various issues: the characteristics of the breast, the availability of previous examinations, the availability of technology and also the radiologist’s preference in relation to the specific case.…”

Section: New Mammographic Techniques: Tomosynthesis and Contrast-enhamentioning

confidence: 99%

Mammography: an update of the EUSOBI recommendations on information for women

et al. 2016

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This article summarises the information to be offered to women about mammography. After a delineation of the aim of early diagnosis of breast cancer, the difference between screening mammography and diagnostic mammography is explained. The need to bring images and reports from the previous mammogram (and from other recent breast imaging examinations) is highlighted. Mammography technique and procedure are described with particular attention to discomfort and pain experienced by a small number of women who undergo the test. Information is given on the recall during a screening programme and on the request for further work-up after a diagnostic mammography. The logic of the mammography report and of classification systems such as R1-R5 and BI-RADS is illustrated, and brief but clear information is given about the diagnostic performance of the test, with particular reference to interval cancers, i.e., those cancers that are missed at screening mammography. Moreover, the breast cancer risk due to radiation exposure from mammography is compared to the reduction in mortality obtained with the test, and the concept of overdiagnosis is presented with a reliable estimation of its extent. Information about new mammographic technologies (tomosynthesis and contrast-enhanced spectral mammography) is also given. Finally, frequently asked questions are answered.Key Points• Direct digital mammography should be preferred to film-screen or phosphor plates.• Screening (in asymptomatic women) should be distinguished from diagnosis (in symptomatic women).• A breast symptom has to be considered even after a negative mammogram.• Digital breast tomosynthesis increases cancer detection and decreases the recall rate.• Contrast-enhanced spectral mammography can help in cancer detection and lesion characterisation.

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Effectiveness of Digital Breast Tomosynthesis Compared With Digital Mammography

Abstract: Digital breast tomosynthesis screening outcomes are sustainable, with significant recall reduction, increasing cancer cases per recalled patients, and a decline in interval cancers.

Cited by 194 publications

References 28 publications

Overdiagnosis in breast imaging

Overdiagnosis in breast imaging

Imaging Surveillance After Primary Breast Cancer Treatment

Mammography: an update of the EUSOBI recommendations on information for women

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