The Effect of Digital Breast Tomosynthesis Adoption on Facility-Level Breast Cancer Screening Volume

Abstract

Objective: To determine whether digital breast tomosynthesis (DBT) adoption was associated with a decrease in screening mammography capacity across Breast Cancer Screening Consortium (BCSC) facilities given concerns about increasing imaging and interpretation times associated with DBT. Materials and Methods: Facility characteristics and examination volume data were collected prospectively from BCSC facilities that adopted DBT between 2011 and 2014. Interrupted time series analyses using Poisson regression models with facility as a random effect were used to evaluate differences between monthly screening volumes during the 12-month pre-adoption period and 12-month post-adoption period (separated by a 3-month lag period) and to test for changes in month-to-month facility-level screening volume during the pre-adoption and post-adoption periods. Results: Across five regional breast imaging registries, 15 out of 83 (18.1%) facilities adopted DBT for screening between 2011 and 2014. The majority had no academic affiliation (73.3%, 11/15), were non-profit (80.0%, 12/15), and were general radiology practices (66.7%, 10/15). Facility-level monthly screening volumes were slightly higher during the post- vs. pre- adoption periods (relative risk [RR] = 1.09, 95% confidence interval [CI] 1.06–1.11). Monthly screening volumes remained relatively stable within the pre-adoption period (RR = 1.00 per month, 95% CI 1.00–1.01) and the post-adoption period (1.00, 95% CI 1.00–1.01). Conclusion: In a cohort of facilities with varied characteristics, monthly screening examination volumes did not decrease after DBT adoption.

Comparative Access to and Use of Digital Breast Tomosynthesis Screening by Women’s Race/Ethnicity and Socioeconomic Status

“…Second, it was not possible for us to examine facility-level workflow processes that may have influenced selection of women for DBT vs DM screening at the time of their imaging (eg, women with dense breasts may have been preferentially scheduled for DBT screening at some facilities, whereas other facilities may schedule women for the first available mammography machine). 32 Third, we did not account for individual breast cancer risk factors, such as breast density or family history, because a prior analysis 9 demonstrated that use of DBT vs DM did not widely differ based on these risk factors. Finally, the BCSC does not have complete ascertainment of insurance status, preventing us from examining this as an exposure.…”

“…First, the BCSC captures data only from women who obtain breast imaging, and thus we cannot examine disparities in DBT vs DM use among women who do not undergo routine screening mammography. Second, it was not possible for us to examine facility-level workflow processes that may have influenced selection of women for DBT vs DM screening at the time of their imaging (eg, women with dense breasts may have been preferentially scheduled for DBT screening at some facilities, whereas other facilities may schedule women for the first available mammography machine) . Third, we did not account for individual breast cancer risk factors, such as breast density or family history, because a prior analysis demonstrated that use of DBT vs DM did not widely differ based on these risk factors.…”

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

“…5,[14][15][16][17] There are also challenges linked with using DBT in organised screening programmes, including increased radiation doses, longer reading times for radiologists, increased cost of the technology and increased data storage requirements. 18 We designed the Proteus Donna RCT to prospectively compare DBT with DM in a population-based screening setting. While its primary outcome was to assess the impact of DBT on ICD, the trial design also allowed us to provide a relevant analysis of CD as a cumulative measure over subsequent screening episodes.…”

“…However, data relating to how this affects interval cancers detection (ICD) and CD at subsequent screening, and whether it produces overdiagnosis are very limited 5,14‐17 . There are also challenges linked with using DBT in organised screening programmes, including increased radiation doses, longer reading times for radiologists, increased cost of the technology and increased data storage requirements 18 . We designed the Proteus Donna RCT to prospectively compare DBT with DM in a population‐based screening setting.…”

Impact of New Technology Adoption on Breast Cancer Screening

“…One might question the usefulness of examining the transition to digital mammography in an era where digital breast tomosynthesis (DBT) is quickly becoming the standard breast cancer screening tool. To date, nearly half of all screening facilities in the United States offer DBT screening (8). In fact, the Tomosynthesis Mammography Imaging Screening Trial (TMIST), a $100 million randomized controlled trial comparing digital mammography to DBT screening, is now underway to compare the effectiveness of DBT to digital mammography (9).…”