Elizabeth A Rafferty1,2, Stephen L Rose3,4, Dave P Miller5, Melissa A Durand6, Emily F Conant7, Debra S Copit8, Sarah M Friedewald9,10, Donna M Plecha11, Ingrid L Ott12, Mary K Hayes13, Kara L Carlson14, Thomas M Cink15, Lora D Barke16, Linda N Greer17, Loren T Niklason18. 1. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. erafferty@lmradiology.com. 2. L&M Radiology, P.O. Box 615, West Acton, MA, 01720, USA. erafferty@lmradiology.com. 3. TOPS Comprehensive Breast Center, Houston, TX, USA. 4. Solis Women's Health, Dallas, TX, USA. 5. Genomic Health, Redwood City, CA, USA. 6. Yale University School of Medicine, New Haven, CT, USA. 7. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 8. Albert Einstein Healthcare Network, Philadelphia, PA, USA. 9. Caldwell Breast Center, Advocate Lutheran General Hospital, Park Ridge, IL, USA. 10. Lynn Sage Comprehensive Breast Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 11. University Hospitals Case Medical Center, Cleveland, OH, USA. 12. Washington Radiology Associates, Fairfax, VA, USA. 13. Radiology Associates of Hollywood and Memorial Healthcare System, Hollywood, FL, USA. 14. Evergreen Health Breast Center and Radia Inc, Kirkland, WA, USA. 15. Edith Sanford Breast Health Institute, Sioux Falls, SD, USA. 16. Invision Sally Jobe Breast Centers and Radiology Imaging Associates, Denver, CO, USA. 17. HonorHealth Breast Health and Research Center, Phoenix, AZ, USA. 18. , Tetonia, ID, USA.
Abstract
PURPOSE: To determine the effect of tomosynthesis imaging as a function of age for breast cancer screening. METHODS: Screening performance metrics from 13 institutions were examined for 12 months prior to introduction of tomosynthesis (period 1) and compared to those after introduction of tomosynthesis (period 2, range 3-22 months). Screening metrics for women ages 40-49, 50-59, 60-69, and 70+ , included rates per 1000 screens for recalls, biopsies, cancers, and invasive cancers detected. RESULTS: Performance parameters were compared for women screened with digital mammography alone (n = 278,908) and digital mammography + tomosynthesis (n = 173,414). Addition of tomosynthesis to digital mammography produced significant reductions in recall rates for all age groups and significant increases in cancer detection rates for women 40-69. Largest recall rate reduction with tomosynthesis was for women 40-49, decreasing from 137 (95% CI 117-156) to 115 (95% CI 95-135); difference, -22 (95% CI -26 to -18; P < .001). Simultaneous increase in invasive cancer detection rate for women 40-49 from 1.6 (95% CI 1.2-1.9) to 2.7 (95% CI 2.2-3.1) with tomosynthesis (difference, 1.1; 95% CI 0.6-1.6; P < .001) was observed. CONCLUSIONS: Addition of tomosynthesis to digital mammography increased invasive cancer detection rates for women 40-69 and decreased recall rates for all age groups with largest performance gains seen in women 40-49. The similar performance seen with tomosynthesis screening for women in their 40s compared to digital mammography for women in their 50s argues strongly for commencement of mammography screening at age 40 using tomosynthesis.
PURPOSE: To determine the effect of tomosynthesis imaging as a function of age for breast cancer screening. METHODS: Screening performance metrics from 13 institutions were examined for 12 months prior to introduction of tomosynthesis (period 1) and compared to those after introduction of tomosynthesis (period 2, range 3-22 months). Screening metrics for women ages 40-49, 50-59, 60-69, and 70+ , included rates per 1000 screens for recalls, biopsies, cancers, and invasive cancers detected. RESULTS: Performance parameters were compared for women screened with digital mammography alone (n = 278,908) and digital mammography + tomosynthesis (n = 173,414). Addition of tomosynthesis to digital mammography produced significant reductions in recall rates for all age groups and significant increases in cancer detection rates for women 40-69. Largest recall rate reduction with tomosynthesis was for women 40-49, decreasing from 137 (95% CI 117-156) to 115 (95% CI 95-135); difference, -22 (95% CI -26 to -18; P < .001). Simultaneous increase in invasive cancer detection rate for women 40-49 from 1.6 (95% CI 1.2-1.9) to 2.7 (95% CI 2.2-3.1) with tomosynthesis (difference, 1.1; 95% CI 0.6-1.6; P < .001) was observed. CONCLUSIONS: Addition of tomosynthesis to digital mammography increased invasive cancer detection rates for women 40-69 and decreased recall rates for all age groups with largest performance gains seen in women 40-49. The similar performance seen with tomosynthesis screening for women in their 40s compared to digital mammography for women in their 50s argues strongly for commencement of mammography screening at age 40 using tomosynthesis.
Entities:
Keywords:
Biopsy; Breast neoplasms; Cancer detection rate; Mammography; Mass screening
Authors: Emily F Conant; William E Barlow; Sally D Herschorn; Donald L Weaver; Elisabeth F Beaber; Anna N A Tosteson; Jennifer S Haas; Kathryn P Lowry; Natasha K Stout; Amy Trentham-Dietz; Roberta M diFlorio-Alexander; Christopher I Li; Mitchell D Schnall; Tracy Onega; Brian L Sprague Journal: JAMA Oncol Date: 2019-05-01 Impact factor: 31.777
Authors: Roxanna J Hellgren; Ann E Sundbom; Kamila Czene; David Izhaky; Per Hall; Paul W Dickman Journal: Eur Radiol Date: 2019-05-21 Impact factor: 5.315