Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening programme (To-Be): a randomised, controlled trial

Hofvind, Solveig; Holen, Åsne Sørlien; Aase, Hildegunn Siv; Houssami, Nehmat; Sebuødegård, Sofie; Moger, Tron Anders; Haldorsen, Ingfrid S.; Akslen, Lars A.

doi:10.1016/s1470-2045(19)30161-5

Cited by 93 publications

(78 citation statements)

References 28 publications

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“…After completely reading these references, 18 studies (comprising 26 articles, since some had more than one published article) met our eligibility criteria and therefore were included in this review [4][5][6][7][8][24][25][26][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] .…”

Section: Resultsmentioning

confidence: 99%

“…These studies included: one RCT 24 , five accuracy studies 7,34,35,40,44 , and eight retrospective cohort studies [4][5][6]8,[36][37][38]46 . Six studies, three accuracy studies 35,43,48 , one prospective cohort study 47 , one RCT 25 and one quasi-RCT 26 evaluated the effectiveness of DBT with synthetic mammography versus digital mammography alone.…”

Section: Resultsmentioning

confidence: 99%

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Accuracy and Effectiveness of Mammography versus Mammography and Tomosynthesis for Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

Giampietro

Cabral

Lima

et al. 2020

Sci Rep

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We proposed to compare the accuracy and effectiveness of digital breast tomosynthesis (DBT), plus digital or synthetic mammography, with digital mammography alone in women attending populationbased breast cancer screenings. We performed a systematic review and included controlled studies comparing DBT with digital mammography for breast cancer screening. Search strategies were applied to the MEDLINE, Embase, LILACS, and CENTRAL databases. With moderate quality of evidence, in 1,000 screens, DBT plus digital mammography increased the overall and invasive breast cancer rates by 3 and 2 (RR 1.36, 95% CI 1.18 to 1.58 and RR 1.51, 95% CI 1.27 to 1.79, respectively). DBT plus synthetic mammography increased both overall and invasive breast cancer rates by 2 (RR 1.38, 95% CI 1.24 to 1.54 and RR 1.37, 95% CI 1.22 to 1.55, respectively). DBT did not improve recall, false positive and false negative rates. However due to heterogeneity the quality of evidence was low. For women attending population-based breast cancer screenings, DBT increases rates of overall and invasive breast cancer. There is no evidence with high or moderate quality showing that DBT compared with digital mammography decreases recall rates, as well as false positive and false negative rates.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Accuracy and Effectiveness of Mammography versus Mammography and Tomosynthesis for Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

Giampietro

Cabral

Lima

et al. 2020

Sci Rep

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“…Regarding specificity, there is no consensus on whether DBT specificity is improved compared to DM. Some studies showed that specificity can be improved with adjunct DBT compared to DM alone [43,44]. However, a meta-analysis addressed that the recall rate of adjunct DBT increased slightly in European countries, where the recall rate of DM was relatively low compared to other regions such as the USA [9].…”

Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program

et al. 2020

Self Cite

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Objectives To evaluate at which sensitivity digital breast tomosynthesis (DBT) would become cost-effective compared to digital mammography (DM) in a population breast cancer screening program, given a constant estimate of specificity. Methods In a microsimulation model, the cost-effectiveness of biennial screening for women aged 50–75 was simulated for three scenarios: DBT for women with dense breasts and DM for women with fatty breasts (scenario 1), DBT for the whole population (scenario 2) or maintaining DM screening (reference). For DM, sensitivity was varied depending on breast density from 65 to 87%, and for DBT from 65 to 100%. The specificity was set at 96.5% for both DM and DBT. Direct medical costs were considered, including screening, biopsy and treatment costs. Scenarios were considered to be cost-effective if the incremental cost-effectiveness ratio (ICER) was below €20,000 per life year gain (LYG). Results For both scenarios, the ICER was more favourable at increasing DBT sensitivity. Compared with DM screening, 0.8–10.2% more LYGs were found when DBT sensitivity was at least 75% for scenario 1, and 4.7–18.7% when DBT sensitivity was at least 80% for scenario 2. At €96 per DBT, scenario 1 was cost-effective at a DBT sensitivity of at least 90%, and at least 95% for scenario 2. At €80 per DBT, these values decreased to 80% and 90%, respectively. Conclusion DBT is more likely to be a cost-effective alternative to mammography in women with dense breasts. Whether DBT could be cost-effective in a general population highly depends on DBT costs. Key Points • DBT could be a cost-effective screening modality for women with dense breasts when its sensitivity is at least 90% at a maximum cost per screen of €96. • DBT has the potential to be cost-effective for screening all women when sensitivity is at least 90% at a maximum cost per screen of €80. • Whether DBT could be used as an alternative to mammography for screening all women is highly dependent on the cost of DBT per screen.

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“…However, supplementary ultrasounds also increase the rate of recall for further testing (e.g., biopsy) for women who do not have breast cancer, known as a "false positive" [20]. Tomosynthesis (also known as three-dimensional mammography) is a screening modality that increases cancer detection compared to mammography, including in women with dense breasts [21]; however, no randomised-controlled trials have been conducted long enough to investigate improvements in interval cancer-detection rates or survival rates [22]. A randomised-controlled trial demonstrated diagnosis of significantly fewer interval cancers when adjunct magnetic resonance imaging was used for women with extremely dense breasts compared to mammography alone during a 2-year screening period [23].…”

Section: Uncertainties In Measurement and Management Pathwaysmentioning

confidence: 99%

Breast Density Notification: An Australian Perspective

Ingman

Richards

Street

et al. 2020

JCM

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Breast density, also known as mammographic density, refers to white and bright regions on a mammogram. Breast density can only be assessed by mammogram and is not related to how breasts look or feel. Therefore, women will only know their breast density if they are notified by the radiologist when they have a mammogram. Breast density affects a woman’s breast cancer risk and the sensitivity of a screening mammogram to detect cancer. Currently, the position of BreastScreen Australia and the Royal Australian and New Zealand College of Radiologists is to not notify women if they have dense breasts. However, patient advocacy organisations are lobbying for policy change. Whether or not to notify women of their breast density is a complex issue and can be framed within the context of both public health ethics and clinical ethics. Central ethical themes associated with breast density notification are equitable care, patient autonomy in decision-making, trust in health professionals, duty of care by the physician, and uncertainties around evidence relating to measurement and clinical management pathways for women with dense breasts. Legal guidance on this issue must be gained from broad legal principles found in the law of negligence and the test of materiality. We conclude a rigid legal framework for breast density notification in Australia would not be appropriate. Instead, a policy framework should be developed through engagement with all stakeholders to understand and take account of multiple perspectives and the values at stake.

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Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening programme (To-Be): a randomised, controlled trial

Abstract: Two-view digital breast tomosynthesis versus digital mammography in a population-based breast cancer screening program (To-Be): a randomized, controlled trialTomosynthesis breast in screeninga randomized controlled trial

Cited by 93 publications

References 28 publications

Accuracy and Effectiveness of Mammography versus Mammography and Tomosynthesis for Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

Accuracy and Effectiveness of Mammography versus Mammography and Tomosynthesis for Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis

The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program

Breast Density Notification: An Australian Perspective

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