Highlights
- •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).
Abstract
Introduction
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).
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: March 09, 2021
Accepted:
January 28,
2021
Received in revised form:
January 25,
2021
Received:
September 7,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
