Screening Outcomes Following Implementation of Digital Breast Tomosynthesis in a General-Population Screening Program

McCarthy, Anne Marie; Kontos, Despina; Synnestvedt, Marie; Tan, Kay See; Heitjan, Daniel F.; Schnall, Mitchell D.; Conant, Emily F.

doi:10.1093/jnci/dju316

Cited by 171 publications

(105 citation statements)

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“…As expected, the greatest gains in sensitivity were observed for younger women and those with heterogeneously dense breasts [36,37], but interestingly, there was no significant increase in cancer detection in those with extremely dense breasts [37]. DBT is currently being used in Australia as a diagnostic tool, but there is increasing evidence to suggest that it may be beneficial as a screening tool [33][34][35][36]. However, it is common practice to use DBT in conjunction with, rather than instead of, digital mammography, which results in a total examination dose approximately 2-3 times that of digital mammography alone.…”

Section: Advances In Technologysupporting

confidence: 80%

“…The main advantage of DBT is that it significantly reduces the effects of superimposition, thereby enabling visualisation of lesions that would be masked by over-or under-lying tissue and distinguishing real lesions from those mimicked by superimposition of normal structures [29]. A number of studies on large screening populations showed an increase in overall cancer detection rate and a reduction in recall rate when using DBT in addition to 2D digital mammography, compared to using 2D digital mammography alone [33][34][35][36]. As expected, the greatest gains in sensitivity were observed for younger women and those with heterogeneously dense breasts [36,37], but interestingly, there was no significant increase in cancer detection in those with extremely dense breasts [37].…”

Section: Advances In Technologymentioning

confidence: 99%

“…A number of studies on large screening populations showed an increase in overall cancer detection rate and a reduction in recall rate when using DBT in addition to 2D digital mammography, compared to using 2D digital mammography alone [33][34][35][36]. As expected, the greatest gains in sensitivity were observed for younger women and those with heterogeneously dense breasts [36,37], but interestingly, there was no significant increase in cancer detection in those with extremely dense breasts [37]. DBT is currently being used in Australia as a diagnostic tool, but there is increasing evidence to suggest that it may be beneficial as a screening tool [33][34][35][36].…”

Section: Advances In Technologymentioning

confidence: 99%

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How many physicists does it take to test a mammography unit?

Diffey¹

2017

Australas Phys Eng Sci Med

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Mammography is defined as the X-ray examination of the breast. It is just one of the modalities used for breast imaging; ultrasound and magnetic resonance imaging (MRI) are incredibly valuable adjunct techniques and newer technologies are gradually being adopted, such as molecular breast imaging and dedicated breast computed tomography. Inevitably, we tend to associate the term breast imaging with breast screening. Although breast screening has its critics [3], there can be no doubt that breast cancer is a major health burden on a global scale; it is the second most common cancer in the world and is responsible for more female deaths than any other cancer type [4]. Within Australia, 1 in 8 women will be diagnosed with breast cancer by the age of 85 [5]. However, it is reassuring to note that mortality rates are decreasing despite the fact that incidence rates continue to rise and the diagnosis rates in young women are increasing [6].Mammography is considered to be the gold standard for breast screening, having an overall sensitivity of about 85% and specificity of 90% [7] in women aged 50-70. Breast imaging is challenging since it is necessary to detect and classify pathological details (microcalcifications and masses) against a background of fibrous tissue, which can vary considerably in radiological appearance depending on breast thickness and composition.Microcalcifications have a relatively high atomic number and density and hence high inherent and subject contrast. Unfortunately they are generally very small in size, ranging from 10 µm through to several mm [8]. Although masses are of moderate size (5-10 mm), detection of carcinoma is difficult since malignant tissue has negligible physical density difference from fibrous breast tissue, a similar attenuation coefficient and therefore low inherent contrast I'm sorry to lure you in with a joke for which I don't have a punchline; the answer is just one, yet there are 95 physicists in Australia and New Zealand who hold ACPSEM Certification in Mammography Equipment Testing [1]. To put this into perspective, there are only 41 medical physicists who hold ACPSEM Certification in Radiology [2].This raises the questions of why mammography is the only radiology modality to have its own certification process and why there is so much demand for this qualification. Having spent 12 years specialising in mammography physics, I'll attempt to answer these questions and look at how mammographic technology has changed over the years and how this has impacted the role of the medical physicist.

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Section: Advances In Technologysupporting

confidence: 80%

Section: Advances In Technologymentioning

confidence: 99%

Section: Advances In Technologymentioning

confidence: 99%

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How many physicists does it take to test a mammography unit?

Diffey¹

2017

Australas Phys Eng Sci Med

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“…Hot on the heels of the prospective trials, several retrospective evaluations of DBT in the screening setting have also shown improved detection measures when adjunct DBT is used with mammography: three of these studies [7][8][9] compared detection measures for the same services before and after the introduction of adjunct DBT, one study [10] compared services using standard mammography with services using adjunct DBT within the same timeframe and one study compared contemporaneous groups of women who opted for DBT or for standard screening within community-based radiology services [11]. Although these methodologies provide less direct comparisons for mammography screening with and without adjunct DBT than the prospective studies (which provided within subject comparisons), they also found increased breast cancer detection attributable to DBT in the range of 0.5-1.4/1000 screens [7][8][9][10][11].…”

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confidence: 99%

Digital breast tomosynthesis (3D-mammography) screening: data and implications for population screening

Houssami

2015

Expert Review of Medical Devices

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“…One appeal is the reduction of false-positives (approximately 15%) and increased cancer detection rates (approximately 28%; for invasive cancers, 40% or more) [121][122][123] , together with a onethird reduction in recall rates and consequent false-positive biopsies 117,124,125 , especially in younger women and women with dense breasts in whom mammography is limited, and with no negative effect on sensitivity 123,[126][127][128] , which could potentially tip the risk:benefit ratio toward tomosynthesis 129,130 . And although compared with mammography alone, tomosynthesis roughly doubles total radiation exposure, this can be obviated using the synthesized 2D images created from the three-dimensional tomosynthesis dataset, dramatically reducing the radiation (43% or more) to that of a standard mammogram (eliminating separate 2D exposures), with superior lesion visualization for microcalcification cluster detectability [131][132][133][134][135] , and having the potential to render conventional 2D mammography obsolete 117,123,[135][136][137][138][139][140] .…”

Section: New Screening Modalities: Digital Breast Tomosynthesismentioning

confidence: 99%

Beyond the Mammography Debate: A Moderate Perspective

Kaniklidis¹

2015

Current Oncology

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After some decades of contention, one can almost despair and conclude that (paraphrasing) "the mammography debate you will have with you always." Against that sentiment, in this review I argue, after reflecting on some of the major themes of this long-standing debate, that we must begin to move beyond the narrow borders of claim and counterclaim to seek consensus on what the balance of methodologically sound and critically appraised evidence demonstrates, and also to find overlooked underlying convergences; after acknowledging the reality of some residual and non-trivial harms from mammography, to promote effective strategies for harm mitigation; and to encourage deployment of new screening modalities that will render many of the issues and concerns in the debate obsolete.To these ends, I provide a sketch of what this looking forward and beyond the current debate might look like, leveraging advantages from abbreviated breast magnetic resonance imaging technologies (such as the ultrafast and twist protocols) and from digital breast tomosynthesis-also known as three-dimensional mammography. I also locate the debate within the broader context of mammography in the real world as it plays out not for the disputants, but for the stakeholders themselves: the screening-eligible patients and the physicians in the front lines who are charged with enabling both the acts of screening and the facts of screening at their maximally objective and patientaccessible levels to facilitate informed decisions. Key Words REFLECTIONS ON SOME CENTRAL THEMESAll screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost.-Sir Muir Grey, former director of the U.K. National Screening Committee 1 Some Issues Deserving More AttentionSeveral core issues require closer examination:1. The potential benefits of mammographic screening independent of whether ultimate survival is affected, including diagnosis at earlier stages, typically with smaller tumours and node negativity; reduced likelihood of aggressive treatments and morbidities; detection of high-risk lesions (most diagnosed in the screened group 2 ) allowing for chemoprevention or magnetic resonance imaging (mri) surveillance against occult malignancies, or both; and avoidance of compromised quality of life after diagnosis of advanced disease It is not clear, as often assumed, that survival is the best (or only) measure for judging mammographic screening 2,3 . And it remains open whether claimed harms truly are disproportionate to benefits when using, for instance, a more nuanced definition of overdetection than simply breast cancer (bca) diagnosed but not bca expired (distinguishing, for example, longer recurrence-free survival from simple overall survival benefit).

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Screening Outcomes Following Implementation of Digital Breast Tomosynthesis in a General-Population Screening Program

Abstract: Our data support the clinical implementation of DBT in breast cancer screening; however, larger prospective trials are needed to validate our findings in specific patient subgroups.

Cited by 171 publications

References 20 publications

How many physicists does it take to test a mammography unit?

How many physicists does it take to test a mammography unit?

Digital breast tomosynthesis (3D-mammography) screening: data and implications for population screening

Beyond the Mammography Debate: A Moderate Perspective

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