- •Meta-analysis of digital breast tomosynthesis (DBT) studies reporting screen-detected and interval cancer data.
- •Pooled cancer detection rate (CDR) was 9.03/1000 for DBT population screening.
- •Digital mammography (DM) CDR was 5.95/1000: pooled CDR difference was 3.15/1000.
- •Pooled interval cancer rate (ICR) was 1.56/1000 for DBT and 1.75/1000 for DM.
- •Pooled difference in ICR between DBT and DM was −0.15/1000 (95% CI –0.59 to 0.29).
Breast cancer (BC) screening using digital breast tomosynthesis (DBT) has been shown to increase cancer detection compared with mammography; however, it is unknown whether DBT impacts interval cancer rate (ICR).
We systematically identified prospective DBT studies reporting data on screen-detected and interval BCs to perform a study-level meta-analysis of the comparative effect of DBT on ICR in population screening. Meta-analysis of cancer detection rate (CDR), ICR, and the differences between DBT and mammography in CDR and ICR pooled estimates, included random-effects. Sensitivity analysis examined whether study methods (imaging used, comparison group design, interval BC ascertainment) affected pooled estimates.
Five eligible prospective (non-randomised) studies of DBT population screening reported on 129,969 DBT-screened participants and 227,882 mammography-only screens, including follow-up publications reporting interval BC data. Pooled CDR was 9.03/1000 (95% confidence interval [CI] 8.53–9.56) for DBT, and 5.95/1000 (95% CI 5.65–6.28) for mammography: the pooled difference in CDR was 3.15/1000 (95% CI 2.53–3.77), and was evident for the detection of invasive and in-situ malignancy. Pooled ICR was 1.56/1000 DBT screens (95% CI 1.22–2.00), and 1.75/1000 mammography screens (95% CI 1.46–2.11): the estimated pooled difference in ICR was −0.15/1000 (95% CI –0.59 to 0.29) and was not substantially altered in several sensitivity analyses.
Meta-analysis shows consistent evidence that DBT significantly increased CDR compared with mammography screening; however, there was little difference between DBT and mammography in pooled ICR. This could suggest, but does not demonstrate, some over-detection. Meta-analysis using individual participant data, randomised trials and comparative studies quantifying cumulative detection and ICR over repeat DBT screen-rounds would provide valuable evidence to inform screening programs.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Cancer
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Breast-cancer screening--viewpoint of the IARC working group.N Engl J Med. 2015; 372: 2353-2358
- The benefits and harms of breast cancer screening: an independent review.Br J Canc. 2013; 108: 2205-2240
- Use of digital breast tomosynthesis (DBT).2020 (Online source)https://healthcare-quality.jrc.ec.europa.eu/european-breast-cancer-guidelines/screening-tests/DBT-or-DMDate accessed: December , 2020
- Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study.Lancet Oncol. 2013; : 583-589
- Digital breast tomosynthesis: a brave new world of mammography screening.JAMA Oncol. 2016; 2: 725-727
- Breast cancer screening using tomosynthesis or mammography: a meta-analysis of cancer detection and recall.J Natl Cancer Inst. 2018; 110: 942-949
- Performance of one-view breast tomosynthesis as a stand-alone breast cancer screening modality: results from the Malmo Breast Tomosynthesis Screening Trial, a population-based study.Eur Radiol. 2016; 26: 184-190
- Effectiveness of digital breast tomosynthesis (3D-mammography) in population breast cancer screening: a protocol for a collaborative individual participant data (IPD) meta-analysis.Transl Cancer Res. August 2017; 6 (Translational Cancer Research 2017)
- Interval breast cancers in the ‘screening with tomosynthesis or standard mammography’ (STORM) population-based trial.Breast. 2018; 38: 150-153
- Prospective trial comparing full-field digital mammography (FFDM) versus combined FFDM and tomosynthesis in a population-based screening programme using independent double reading with arbitration.Eur Radiol. 2013; 23: 2061-2071
- Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial.Breast Canc Res Treat. 2018; 169: 489-496
- Digital mammography versus digital mammography plus tomosynthesis in breast cancer screening: the Oslo tomosynthesis screening trial.Radiology. 2019; 291: 23-30
- One-view breast tomosynthesis versus two-view mammography in the Malmo Breast Tomosynthesis Screening Trial (MBTST): a prospective, population-based, diagnostic accuracy study.Lancet Oncol. 2018; 19: 1493-1503
- Interval breast cancer rates and tumor characteristics in the prospective population-based Malmö Breast Tomosynthesis Screening Trial (MBTST).Radiology. 2021; ([in press])
- Digital breast tomosynthesis and synthetic 2D mammography versus digital mammography: evaluation in a population-based screening program.Radiology. 2018; 287: 787-794
- Interval and consecutive round breast cancer after digital breast tomosynthesis and synthetic 2D mammography versus standard 2D digital mammography in BreastScreen Norway.Radiology. 2020; 294: 256-264
- Effect of implementing digital breast tomosynthesis (DBT) instead of mammography on population screening outcomes including interval cancer rates: results of the Trento DBT pilot evaluation.Breast. 2020; 50: 135-140
- Pilot trial of digital breast tomosynthesis (3D mammography) for population-based screening in BreastScreen Victoria.Med J Aust. 2019; 211: 357-362
- A randomized controlled trial of digital breast tomosynthesis versus digital mammography in population-based screening in Bergen: interim analysis of performance indicators from the To-Be trial.Eur Radiol. 2019; 29: 1175-1186
- Digital mammography versus digital mammography plus tomosynthesis for breast cancer screening: the reggio emilia tomosynthesis randomized trial.Radiology. 2018; 288: 375-385
- Digital breast tomosynthesis with synthesized two-dimensional images versus full-field digital mammography for population screening: outcomes from the verona screening program.Radiology. 2018; 287: 37-46
- Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study.Lancet Oncol. 2016; 17: 1105-1113
- Breast cancer characteristics associated with 2D digital mammography versus digital breast tomosynthesis for screening-detected and interval cancers.Radiology. 2018; 287: 49-57
- Effectiveness of digital breast tomosynthesis compared with digital mammography: outcomes analysis from 3 Years of breast cancer screening.JAMA Oncol. 2016; 2: 737-743
- Impact of immediate interpretation of screening tomosynthesis mammography on performance metrics.Acad Radiol. 2019; 26: 210-214
- Increased cancer detection rate and variations in the recall rate resulting from implementation of 3D digital breast tomosynthesis into a population-based screening program.Radiology. 2016; 278: 698-706
- A randomised trial of screening with digital breast tomosynthesis plus conventional digital 2D mammography versus 2D mammography alone in younger higher risk women.Eur J Radiol. 2017; 94: 133-139
- How to perform a meta-analysis with R: a practical tutorial.Evid Base Ment Health. 2019; 22: 153-160
- R: a language and environment for statistical computing.R Foundation for Statistical Computing, Vienna, Austria2020 (2020)
- Digital breast tomosynthesis (DBT): a review of the evidence for use as a screening tool.Clin Radiol. 2016; 71: 141-150
- Benefit of adding digital breast tomosynthesis to digital mammography for breast cancer screening focused on cancer characteristics: a meta-analysis.Breast Canc Res Treat. 2017; 164: 557-569
- Overview of the evidence on digital breast tomosynthesis in breast cancer detection.Breast. 2013; 22: 101-108
- The tomosynthesis mammographic imaging screening trial (TMIST).(Online source)www.cancer.gov/about-cancer/treatment/clinical-trials/nci-supported/tmistDate accessed: December , 2020
Published online: March 09, 2021
Accepted: January 28, 2021
Received in revised form: January 25, 2021
Received: September 7, 2020
© 2021 Elsevier Ltd. All rights reserved.