Breast Cancer Screening Among Medically Underserved Women in New Mexico: Potential for Lower Recall Rates with Digital Breast Tomosynthesis.
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ABSTRACT:
SUBMITTER: Manda-Mapalo MT
PROVIDER: S-EPMC8020518 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
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Breast Cancer Screening Among Medically Underserved Women in New Mexico: Potential for Lower Recall Rates with Digital Breast Tomosynthesis.
Manda-Mapalo Martha T MT Fine Stephanie G SG Safadi Sarah S Lee Ji-Hyun JH Du Ruofei R Sussman Andrew L AL Mishra Shiraz S Selwyn Reed G RG Saline Jennifer L JL Hine Wendy L WL Brown-Glaberman Ursa A UA
Journal of women's health (2002) 20200929 12
<b><i>Introduction:</i></b> Digital breast tomosynthesis (DBT) may decrease recall rates (RRs) and improve positive predictive values (PPVs) and cancer detection rates (CDRs) versus full-field digital mammography (FFDM). The value of DBT has not been assessed in New Mexico's rural and minority population. Objectives of this study were to compare RRs, CDRs, and PPVs using FFDM+DBT versus FFDM in screening mammograms at the University of New Mexico between 2013 and 2016 and to qualitatively evalua ...[more]
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Project description:ImportanceBreast cancer screening examinations using digital breast tomosynthesis (DBT) has been shown to be associated with decreased false-positive test results and increased breast cancer detection compared with digital mammography (DM). Little is known regarding the size and stage of breast cancer types detected and their association with age and breast density.ObjectiveTo determine whether screening examinations using DBT detect breast cancers that are associated with an improved prognosis and to compare the detection rates by patient age and breast density.Design, setting, and participantsThis retrospective analysis of prospective cohort data from 3 research centers in the Population-based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium included data of women aged 40 to 74 years who underwent screening examinations using DM and DBT from January 1, 2011, through September 30, 2014. Statistical analysis was performed from November 8, 2017, to August 14, 2018.ExposuresUse of DBT as a supplement to DM at breast cancer screening examination.Main outcomes and measuresRecall rate, cancer detection rate, positive predictive value, biopsy rate, and distribution of invasive cancer subtypes.ResultsAmong 96 269 women (mean [SD] patient age for all examinations, 55.9 [9.0] years), patient age was 56.4 (9.0) years for DM and 54.6 (8.9) years for DBT. Of 180 340 breast cancer screening examinations, 129 369 examinations (71.7%) used DM and 50 971 examinations (28.3%) used DBT. Screening examination with DBT (73 of 99 women [73.7%]) was associated with the detection of smaller, more often node-negative, HER2-negative, invasive cancers compared with DM (276 of 422 women [65.4%]). Screening examination with DBT was also associated with lower recall (odds ratio, 0.64; 95% CI, 0.57-0.72; P < .001) and higher cancer detection (odds ratio, 1.41; 95% CI, 1.05-1.89; P = .02) compared with DM for all age groups even when stratified by breast density. The largest increase in cancer detection rate and the greatest shift toward smaller, node-negative invasive cancers detected with DBT was for women aged 40 to 49 years. For women aged 40 to 49 years with nondense breasts, the cancer detection rate for examinations using DBT was 1.70 per 1000 women higher compared with the rate using DM; for women with dense breasts, the cancer detection rate was 2.27 per 1000 women higher for DBT. For these younger women, screening with DBT was associated with only 7 of 28 breast cancers (25.0%) categorized as poor prognosis compared with 19 of 47 breast cancers (40.4%) when screening with DM.Conclusions and relevanceThe findings suggest that screening with DBT is associated with increased specificity and an increased proportion of breast cancers detected with better prognosis compared with DM. In the subgroup of women aged 40 to 49 years, routine DBT screening may have a favorable risk-benefit ratio.
| S-EPMC6512257 | biostudies-literature
Project description:ObjectivesTo analyse false positives (FPs) in breast cancer screening with tomosynthesis (BT) vs. mammography (DM).MethodsThe Malmö Breast Tomosynthesis Screening Trial (MBTST) is a prospective population-based study comparing one-view BT to DM in screening. This study is based on the first half of the MBTST population (n = 7,500). Differences in FP recall rate, findings leading to recall, work-up and biopsy rate between cases recalled on BT alone, DM alone and BT+DM were analysed.ResultsThe FP recall rate was 1.7 % for BT alone (n = 131), 0.9 % for DM alone (n = 69) and 1.1 % for BT + DM (n = 81). The FP recall rate for BT alone was halved after the initial phase of the trial, stabilising at 1.5 %. BT doubled the recall of stellate distortions compared to DM (n = 64 vs. n = 33). There were fewer fibroadenomas and cysts, and the biopsy rate was slightly lower for FP recalled on BT alone compared to DM alone (15.3 % vs. 27.6 %: p = 0.037 and 33.8 % vs. 36.2 %; p = 0.641, respectively).ConclusionsFPs increased with BT screening mainly due to the recall of stellate distortions. The FP recall rate was still well within the European guidelines and showed evidence of a learning curve. Characterisation of rounded lesions was improved with BT.Key points• Tomosynthesis screening gave a higher false-positive recall rate than mammography • There was a decline in the false-positive recall rate for tomosynthesis • The recall due to stellate distortions simulating malignancy was doubled with tomosynthesis • Tomosynthesis found more radial and postoperative scar tissue than mammography • Tomosynthesis is better at characterising rounded lesions.
| S-EPMC5052302 | biostudies-literature
Project description:BackgroundDigital 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.MethodsUsing 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 DBT-screened 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.FindingsFour 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: 8.25-21.02). Pooled ICR was higher in the high-density (21.08/10,000; 95%CI: 6.71-66.27) than the low-density (8.63/10,000; 95%CI: 5.25-14.192) 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: 13.22-23.66), DBT's pooled ICR was 16.83/10,000 (95%CI: 11.89-23.82). Comparative meta-analysis showed a non-significant difference in ICR (-0.44/10,000; 95%CI: -11.00-10.11) and non-significant difference in screening sensitivity (6.79%; 95%CI: -0.73-14.87%) between DBT and DM but a significant pooled difference in cancer detection rate of 33.49/10,000 (95%CI: 23.88-43.10). 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).InterpretationAlthough 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.
| S-EPMC8102709 | biostudies-literature
Project description:BackgroundThe performance of digital breast tomosynthesis (DBT) alone, digital mammography (DM) plus DBT, and synthesized mammography (SM) plus DBT, in comparison to DM in breast cancer screening, remains a topic of ongoing debate. The effectiveness of these modalities in reducing interval cancer rates (ICR) is particularly contentious.Materials and methodsA database of data was searched for articles published until July 2024. Initially, the pooled sensitivity and specificity of DBT (DBT alone, DM/DBT, and SM/DBT) and DM were estimated. Additionally, the sensitivity of breast cancer screening and ICR for DBT alone, DM/DBT, and SM/DBT compared to DM. The characteristics of interval breast cancer were compared with those screening BC, alongside differences across various screening methods.ResultsEleven studies comparing DBT and DM were included. The sensitivity of DBT was higher than that of DM, with rates of 86% (95%CI: 81, 90) and 80% (95%CI: 76, 84), respectively. The specificities of both modalities were similar, recorded at 96% (95%CI: 95, 98) and 96% (95%CI: 95, 97), respectively. In comparison to DM, the screening sensitivities of DBT, DM/DBT, and SM/DBT were increased by 4.33% (95% CI: 1.52, 7.13), 6.29% (95% CI: 2.55, 10.03), and 5.22% (95% CI: 1.35, 9.10), respectively; however, the difference in the ICR was not statistically significant.ConclusionDBT offers advantages in enhancing the sensitivity of breast cancer screening; however, its impact on ICR remains uncertain. Consequently, further research is necessary to comprehensively evaluate both the effectiveness of screening and the potential risks associated with DBT.
| S-EPMC11785311 | biostudies-literature
Project description:Purpose To evaluate Breast Imaging Reporting and Data System (BI-RADS) category 3 assessment at diagnostic examination after recall from screening in a large urban population after implementation of digital breast tomosynthesis (DBT) by focusing both on overall use and use stratified by recalled finding type and outcome at 2 years. Materials and Methods This was an intuitional review board-approved and HIPAA-compliant retrospective review of 10 728 digital mammography (DM) examinations from September 1, 2010, to August 30, 2011, and 15 571 screening DBT examinations from October 1, 2011, to February 28, 2013. The recall populations for DM and DBT were 1112 of 10 728 (10.4% of women screened) and 1366 of 15 571 (8.8% of women screened), respectively. Recall examinations were classified according to finding type: calcifications, asymmetry or focal asymmetry, mass, and architectural distortion. Differences between groups were compared by using the χ2 test. Results Although there was no significant change in the utilization rate of BI-RADS category 3 in those patients screened with DM compared with DBT (168 of 10 728, 1.6% for DM vs 206 of 15 571, 1.3% for DBT; P = .102), there was a mean overall reduction of 2.4 women per 1000 (95% confidence interval [CI]: -0.5, 5.4) recommended for short-term follow-up. Lesion types given a BI-RADS category 3 assessment after diagnostic work-up did not change. The distribution of recalled finding types significantly changed with DBT, with increased recall examinations for architectural distortion and mass (P < .001) and decreased recall examinations for asymmetries (P ≤ .001). There was no change in recall examinations for calcifications (P = .977). Conclusion Screening with DBT did not significantly change the utilization rate of BI-RADS category 3 classification; however, the overall number of patients recommended for short-interval follow-up decreased by a mean of 2.4 women per 1000 (95% CI: -0.5, 5.4). © RSNA, 2017 Online supplemental material is available for this article.
| S-EPMC5708302 | biostudies-literature
Project description:Background Breast Imaging Reporting and Data System (BI-RADS) breast density categories assigned by interpreting radiologists often influence decisions surrounding supplemental breast cancer screening and risk assessment. The landscape of mammographic screening continuously evolves, and different mammographic screening modalities may result in different perception of density, reflected in different assignment of BI-RADS density categories. Purpose To investigate the effect of screening mammography modality on BI-RADS breast density assessments. Materials and Methods Data were retrospectively analyzed from 24 736 individual women (42.3% [10 455 of 24 736] white women, 57.7% [14 281 of 24 736] black women; mean age, 56.3 years; age range, 40.0-74.9 years) who underwent from one to seven mammographic screening examinations from September 2010 through February 2017 (60 766 examinations). Three screening modalities were used: digital mammography alone (8935 examinations); digital mammography with digital breast tomosynthesis (DBT; 30 779 examinations); and synthetic mammography with DBT (21 052 examinations). Random-effects logistic regression analysis was performed to estimate the likelihood of assignment to high versus low BI-RADS density category according to each modality, adjusted for ethnicity, age, body mass index (BMI), and radiologist. The interactions of modality with ethnicity and BMI on density categorization were also tested with the model. Results Women screened with DBT versus digital mammography alone had lower likelihood regarding categorization of high density breasts (digital mammography and DBT vs digital mammography: odds ratio, 0.69 [95% confidence interval: 0.61, 0.80], P < .001; synthetic mammography and DBT vs digital mammography: odds ratio, 0.43 [95% confidence interval: 0.37, 0.50], P < .001). Lower likelihood of high density was also observed at synthetic mammography and DBT compared with digital mammography and DBT (odds ratio, 0.62; 95% confidence interval: 0.56, 0.69; P < .001). There were interactions of modality with ethnicity (P = .007) and BMI (P = .003) on breast density assessment, with greater differences in density categorization according to modality observed for black women than for white women and groups with higher BMI. Conclusion Breast density categorization may vary by screening mammographic modality, and this effect appears to vary by ethnicity and body mass index. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Philpotts in this issue.
| S-EPMC6493215 | biostudies-literature
Project description:ImportanceMany US radiologists have screening mammography recall rates above the expert-recommended threshold of 12%. The influence of digital breast tomosynthesis (DBT) on the distribution of radiologist recall rates is uncertain.ObjectiveTo evaluate radiologists' recall and cancer detection rates before and after beginning interpretation of DBT examinations.Design, setting, and participantsThis cohort study included 198 radiologists from 104 radiology facilities in the Breast Cancer Surveillance Consortium who interpreted 251 384 DBT and 2 000 681 digital mammography (DM) screening examinations from 2009 to 2017, including 126 radiologists (63.6%) who interpreted DBT examinations during the study period and 72 (36.4%) who exclusively interpreted DM examinations (to adjust for secular trends). Data were analyzed from April 2018 to July 2019.ExposuresDigital breast tomosynthesis and DM screening examinations.Main outcomes and measuresRecall rate and cancer detection rate.ResultsA total of 198 radiologists interpreted 2 252 065 DM and DBT examinations (2 000 681 [88.8%] DM examinations; 251 384 [11.2%] DBT examinations; 710 934 patients [31.6%] aged 50-59 years; 1 448 981 [64.3%] non-Hispanic white). Among the 126 radiologists (63.6%) who interpreted DBT examinations, 83 (65.9%) had unadjusted DM recall rates of no more than 12% before using DBT, with a median (interquartile range) recall rate of 10.0% (7.5%-13.0%). On DBT examinations, 96 (76.2%) had an unadjusted recall rate of no more than 12%, with a median (interquartile range) recall rate of 8.8% (6.3%-11.3%). A secular trend in recall rate was observed, with the multivariable-adjusted risk of recall on screening examinations declining by 1.2% (95% CI, 0.9%-1.5%) per year. After adjusting for examination characteristics and secular trends, recall rates were 15% lower on DBT examinations compared with DM examinations interpreted before DBT use (relative risk, 0.85; 95% CI, 0.83-0.87). Adjusted recall rates were significantly lower on DBT examinations compared with DM examinations interpreted before DBT use for 45 radiologists (35.7%) and significantly higher for 18 (14.3%); 63 (50.0%) had no statistically significant change. The unadjusted cancer detection rate on DBT was 5.3 per 1000 examinations (95% CI, 5.0-5.7 per 1000 examinations) compared with 4.7 per 1000 examinations (95% CI, 4.6-4.8 per 1000 examinations) on DM examinations interpreted before DM use (multivariable-adjusted risk ratio, 1.21; 95% CI, 1.11-1.33).Conclusions and relevanceIn this study, DBT was associated with an overall decrease in recall rate and an increase in cancer detection rate. However, our results indicated that there is wide variability among radiologists, including a subset of radiologists who experienced increased recall rates on DBT examinations. Radiology practices should audit radiologist DBT screening performance and consider additional DBT training for radiologists whose performance does not improve as expected.
| S-EPMC7292996 | biostudies-literature
Project description:ImportanceDigital mammography (DM) and digital breast tomosynthesis (DBT) are used for routine breast cancer screening. There is minimal evidence on performance outcomes by age, screening round, and breast density in community practice.ObjectiveTo compare DM vs DBT performance by age, baseline vs subsequent screening round, and breast density category.Design, setting, and participantsThis comparative effectiveness study assessed 1 584 079 screening examinations of women aged 40 to 79 years without prior history of breast cancer, mastectomy, or breast augmentation undergoing screening mammography at 46 participating Breast Cancer Surveillance Consortium facilities from January 2010 to April 2018.ExposuresAge, Breast Imaging Reporting and Data System breast density category, screening round, and modality.Main outcomes and measuresAbsolute rates and relative risks (RRs) of screening recall and cancer detection.ResultsOf 1 273 492 DM and 310 587 DBT examinations analyzed, 1 028 891 examinations (65.0%) were of white non-Hispanic women; 399 952 women (25.2%) were younger than 50 years; and 671 136 women (42.4%) had heterogeneously dense or extremely dense breasts. Adjusted differences in DM vs DBT performance were largest on baseline examinations: for example, per 1000 baseline examinations in women ages 50 to 59, recall rates decreased from 241 examinations for DM to 204 examinations for DBT (RR, 0.84; 95% CI, 0.73-0.98), and cancer detection rates increased from 5.9 with DM to 8.8 with DBT (RR, 1.50; 95% CI, 1.10-2.08). On subsequent examinations, women aged 40 to 79 years with heterogeneously dense breasts had improved recall rates and improved cancer detection with DBT. For example, per 1000 examinations in women aged 50 to 59 years, the number of recall examinations decreased from 102 with DM to 93 with DBT (RR, 0.91; 95% CI, 0.84-0.98), and cancer detection increased from 3.7 with DM to 5.3 with DBT (RR, 1.42; 95% CI, 1.23-1.64). Women aged 50 to 79 years with scattered fibroglandular density also had improved recall and cancer detection rates with DBT. Women aged 40 to 49 years with scattered fibroglandular density and women aged 50 to 79 years with almost entirely fatty breasts benefited from improved recall rates without change in cancer detection rates. No improvements in recall or cancer detection rates were observed in women with extremely dense breasts on subsequent examinations for any age group.Conclusions and relevanceThis study found that improvements in recall and cancer detection rates with DBT were greatest on baseline mammograms. On subsequent screening mammograms, the benefits of DBT varied by age and breast density. Women with extremely dense breasts did not benefit from improved recall or cancer detection with DBT on subsequent screening rounds.
| S-EPMC7388021 | biostudies-literature
Project description:BackgroundDigital breast tomosynthesis (DBT) combined with digital mammography (DM) is increasingly used in the United States instead of DM alone for breast cancer screening. Early screening outcomes incorporating synthetic mammography (SM) with DBT have suggested that SM is an acceptable non-radiation dose alternative to DM.PurposeTo compare multicenter outcomes from breast cancer screening with SM/DBT versus DM/DBT.Materials and MethodsThis was a retrospective study of consecutive screening mammograms obtained at two institutions. Eligible studies consisted of 34 106 DM/DBT examinations between October 3, 2011, and October 31, 2014, and 34 180 SM/DBT examinations between January 7, 2015, and February 2, 2018, at the University of Pennsylvania and 51 148 DM/DBT examinations between January 1, 2012, and May 31, 2016, and 31 929 SM/DBT examinations between June 1, 2016, and March 30, 2018, at the University of Vermont. Demographics of women who attended screening and results from screening were recorded. Recall rate, biopsy rate, false-negative rate, cancer detection rate, positive predictive value, sensitivity, and specificity were calculated according to modality and institution. Descriptive statistics, χ2 tests, and logistic regression were used in analysis.ResultsThe study included 151 363 screening examinations among 151 363 women (mean age, 58.1 years ± 10.9 [standard deviation]). The unadjusted recall rate was lower with SM/DBT than with DM/DBT (7.0% [4630 of 66 109 examinations] for SM/DBT vs 7.9% [6742 of 85 254 examinations] for DM/DBT; P < .01). However, after multivariable adjustment, SM/DBT was associated with a slightly higher recall rate compared with DM/DBT (adjusted odds ratio [OR], 1.06; adjusted 95% CI: 1.01, 1.11; P = .02). Similarly, after multivariable adjustment, SM/DBT was associated with slightly lower specificity compared with DM/DBT (adjusted OR, 0.95; adjusted 95% CI: 0.90, 0.99; P = .02). There was no statistically significant difference in biopsy rate (P = .54), false-negative rate (P = .38), cancer detection rate (P = .55), invasive or in situ cancer detection rate (P = .52 and P = .98, respectively), positive predictive value (P = .78), or sensitivity (P = .33) for SM/DBT versus DM/DBT overall or within either institution (P > .05 for all).ConclusionBreast cancer screening performance is maintained within benchmarks when synthetic mammography replaces digital mammography in digital breast tomosynthesis imaging.© RSNA, 2020Online supplemental material is available for this article.See also the editorial by Lång in this issue.
| S-EPMC7706877 | biostudies-literature
Project description:Breast cancer is emerging as the most common malignancy in Indian women. Mammography is one of the few screening modalities available to the modern world that has proved itself of much use by aiding early detection and treatment of non-palpable, node-negative breast cancers. However, due to its two-dimensional nature, many cases of malignancies are still missed, to be detected at a later date or by an alternate modality. In 2011, FDA approved the supplemental use of digital breast tomosynthesis (DBT) in screening and diagnostic set ups. The acquisition of multiple low-dose projection images of the compressed parenchyma provided a 'third' dimension to the mammogram whereby the breast tissue could be seen layer by layer on the workstation. It improves cancer detection rate, and reduces recall rate and false-positive findings by improving lesion characterization. The current review discusses the principle of DBT with a comprehensive study of the literature.Supplementary informationThe online version contains supplementary material available at 10.1007/s13193-021-01310-y.
| S-EPMC8272763 | biostudies-literature