TY - JOUR
T1 - Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program
AU - McCarthy, Anne Marie
AU - Kontos, Despina
AU - Synnestvedt, Marie
AU - Tan, Kay See
AU - Heitjan, Daniel F.
AU - Schnall, Mitchell
AU - Conant, Emily F.
N1 - Funding Information:
This work was supported by a U54 grant from the National Cancer Institute at the National Institutes of Health: Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) Network (U54CA163313).
Publisher Copyright:
© The Author 2014.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - Background Early data on breast cancer screening utilizing digital breast tomosynthesis (DBT) combined with digital mammography (DM) have shown improvements in false-positive and false-negative screening rates compared with DM alone. However, these trials were performed at sites where conventional mammographic screening was concurrently performed, possibly leading to selection biases or with complex, multireader algorithms not reflecting general clinical practice. Our study reports the impact on screening outcomes for DBT screening implemented in an entire clinic population. Methods Recall rates, cancer detection, and positive predictive values of screening were compared for 15 571 women screened with DBT and 10 728 screened with DM alone prior to DBT implementation at a single breast imaging center. Generalized linear mixed-effects models were used to estimate the odds ratio (OR) for recall rate adjusted for age, race, presence of prior mammograms, breast density and reader. All statistical tests were two-sided. Results DBT screening showed a statistically significant reduction in recalls compared to DM alone. For the entire population, there were 16 fewer recalls (8.8% vs 10.4%, P.001, adjusted OR = 0.80, 95% confidence interval [CI] = 0.74 to 0.88, P .001) and 0.9 additional cancers detected per 1000 screened with DBT compared to DM alone. There was a statistically significant increase in PPV1 (6.2% vs 4.4%, P = .047). In women younger than age 50 years screened with DBT, there were 17 fewer recalls (12.3% vs 14.0%, P = .02) and 3.6 additional cancer detected per 1000 screened (5.7 vs 2.2 per 1000, P = .02). Conclusions 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.
AB - Background Early data on breast cancer screening utilizing digital breast tomosynthesis (DBT) combined with digital mammography (DM) have shown improvements in false-positive and false-negative screening rates compared with DM alone. However, these trials were performed at sites where conventional mammographic screening was concurrently performed, possibly leading to selection biases or with complex, multireader algorithms not reflecting general clinical practice. Our study reports the impact on screening outcomes for DBT screening implemented in an entire clinic population. Methods Recall rates, cancer detection, and positive predictive values of screening were compared for 15 571 women screened with DBT and 10 728 screened with DM alone prior to DBT implementation at a single breast imaging center. Generalized linear mixed-effects models were used to estimate the odds ratio (OR) for recall rate adjusted for age, race, presence of prior mammograms, breast density and reader. All statistical tests were two-sided. Results DBT screening showed a statistically significant reduction in recalls compared to DM alone. For the entire population, there were 16 fewer recalls (8.8% vs 10.4%, P.001, adjusted OR = 0.80, 95% confidence interval [CI] = 0.74 to 0.88, P .001) and 0.9 additional cancers detected per 1000 screened with DBT compared to DM alone. There was a statistically significant increase in PPV1 (6.2% vs 4.4%, P = .047). In women younger than age 50 years screened with DBT, there were 17 fewer recalls (12.3% vs 14.0%, P = .02) and 3.6 additional cancer detected per 1000 screened (5.7 vs 2.2 per 1000, P = .02). Conclusions 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.
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U2 - 10.1093/jnci/dju316
DO - 10.1093/jnci/dju316
M3 - Article
C2 - 25313245
AN - SCOPUS:84985034252
SN - 0027-8874
VL - 106
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
IS - 11
M1 - dju316
ER -