Interval breast cancer rates for digital breast tomosynthesis versus digital mammography population screening: An individual participant data meta-analysis

Abstract

Background: Digital breast tomosynthesis (DBT) improves breast cancer (BC) detection compared to mammography, however, it is unknown whether this reduces interval cancer rate (ICR) at follow-up. Methods: Using individual participant data (IPD) from DBT screening studies (identified via periodic literature searches July 2016 to November 2019) we performed an IPD meta-analysis. We estimated ICR for DBTscreened participants and the difference in pooled ICR for DBT and mammography-only screening, and compared interval BC characteristics. Two-stage meta-analysis (study-specific estimation, pooled synthesis) of ICR included random-effects, adjusting for study and age, and was estimated in age and density subgroups. Comparative screening sensitivity was calculated using screen-detected and interval BC data. Findings: Four prospective DBT studies, from European population-based programs, contributed IPD for 66,451 DBT-screened participants: age-adjusted pooled ICR was 13.17/10,000 (95%CI: 8.25À21.02). Pooled ICR was higher in the high-density (21.08/10,000; 95%CI: 6.71À66.27) than the low-density (8.63/10,000; 95%CI: 5.25À14.192) groups (P = 0.03) however estimates did not differ across age-groups (P = 0.32). Based on two studies that also provided data for 153,800 mammography screens (age-adjusted ICR 17.69/10,000; 95%CI: 13.22À23.66), DBT's pooled ICR was 16.83/10,000 (95%CI: 11.89À23.82). Comparative meta-analysis showed a non-significant difference in ICR (-0.44/10,000; 95%CI: -11.00À10.11) and non-significant difference in screening sensitivity (6.79%; 95%CI: -0.73À14.87%) between DBT and DM but a significant pooled difference in cancer detection rate of 33.49/10,000 (95%CI: 23.88À43.10). Distribution of interval BC prognostic characteristics did not differ between screening modalities except that those occurring in DBT-screened participants were significantly more likely to be negative for axillary-node metastases (P = 0.005). Interpretation: Although heterogeneity in ICR estimates and few datasets limit recommendations, there was no difference between DBT and mammography in pooled ICR despite DBT increasing cancer detection.

A randomised controlled trial of digital breast tomosynthesis vs digital mammography as primary screening tests: Screening results over subsequent episodes of the Proteus Donna study

“…These results are in line with results from prospective studies, as for CD at baseline, 5,9,28 interval cancer 5,28 and subsequent screening 16,17 …”

“…These results are in line with results from prospective studies, as for CD at baseline, 5,9,28 interval cancer 5,28 and subsequent screening. 16,17 This design allows to evaluate whether a net increase in CD of DBT vs DM exists in the screened population, overcoming the potential bias of the learning curve linked to successive DBT rounds, and to estimate the lead time gain of DBT vs DM.…”

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

“…However, even larger studies on aggregated data are necessary. Our study has been included in published meta-analyses on interval cancer, but even these meta-analyses proved to be insufficiently powered (166,167). Additional long-term studies on interval cancer rates in consecutive screening rounds may add knowledge.…”

Evaluation of average glandular dose (AGD) in screening and diagnostic digital mammography and digital breast tomosynthesis (DBT) towards establishing a reference dose range band (DRB): a developing country experience

“…Many studies have shown that the combination of DBT with FFDM enhances breast cancer detection while reducing the recall rate during screening [13][14][15]. For diagnostic purposes, DBT demonstrates a comparatively higher breast cancer detection rate than FFDM alone [16,17]. However, the DBT procedure combined with a 2D-digital mammographic (2D-DM) image doubles the radiation dose, although it provides more accurate details than a DM image alone [10].…”