Anthony J Maxwell1, Michael Michell2, Yit Y Lim3, Susan M Astley4, Mary Wilson5, Emma Hurley6, D Gareth Evans7, Anthony Howell8, Asif Iqbal9, John Kotre10, Stephen Duffy11, Julie Morris12. 1. Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK; Division of Informatics Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester, M13 9PT, UK. Electronic address: anthony.maxwell@manchester.ac.uk. 2. Breast Radiology Department, King's College Hospital, London, SE5 9RS, UK. Electronic address: michael.michell@nhs.net. 3. Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK. Electronic address: yit.lim@uhsm.nhs.uk. 4. Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK; Division of Informatics Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester, M13 9PT, UK. Electronic address: sue.astley@manchester.ac.uk. 5. Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK. Electronic address: mary.wilson@uhsm.nhs.uk. 6. Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK. Electronic address: emma.hurley@uhsm.nhs.uk. 7. Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK; Genomic Medicine, Manchester Academic Health Sciences Centre, University of Manchester and Central Manchester Foundation Trust, Manchester M13 9WL, UK. Electronic address: gareth.evans@cmft.nhs.uk. 8. Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, M20 4QL, UK. Electronic address: tony.howell@ics.manchester.ac.uk. 9. Breast Radiology Department, King's College Hospital, London, SE5 9RS, UK. Electronic address: asif.iqbal@nhs.net. 10. Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, M20 4BX, UK. Electronic address: kotre@hotmail.co.uk. 11. Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK. Electronic address: s.w.duffy@qmul.ac.uk. 12. Medical Statistics, University Hospital of South Manchester, Manchester, M23 9LT, UK; Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK. Electronic address: julie.morris@manchester.ac.uk.
Abstract
INTRODUCTION: Digital breast tomosynthesis (DBT) has been shown to increase invasive cancer detection rates at screening compared to full field digital (2D) mammography alone, and some studies have reported a reduction in the screening recall rate. No prospective randomised studies of DBT have previously been published. This study compares recall rates with 2D mammography with and without concurrent DBT in women in their forties with a family history of breast cancer undergoing incident screening. MATERIALS AND METHODS: Asymptomatic women aged 40-49 who had previously undergone mammography for an increased risk of breast cancer were recruited in two screening centres. Participants were randomised to screening with 2D mammography only at the first study screen followed a year later by screening with 2D plus DBT, or vice versa. Recall rates were compared using an intention to treat analysis. Reading performance was analysed for the larger centre. RESULTS: 1227 women were recruited. 1221 first screens (604 2D, 617 2D+DBT) and 1124second screens (558 2D+DBT, 566 2D) were analysed. Eleven women had screen-detected cancers: 5 after 2D, 6 after 2D+DBT. The false positive recall rates were 2.4% for 2D and 2.2% for 2D+DBT (p=0.89). There was a significantly greater reduction between rounds in the number of women with abnormal reads who were not recalled after consensus/arbitration with 2D+DBT than 2D (p=0.023). CONCLUSION: The addition of DBT to 2D mammography in incident screening did not lead to a significant reduction in recall rate. DBT may increase reader uncertainty until DBT screening experience is acquired.
INTRODUCTION: Digital breast tomosynthesis (DBT) has been shown to increase invasive cancer detection rates at screening compared to full field digital (2D) mammography alone, and some studies have reported a reduction in the screening recall rate. No prospective randomised studies of DBT have previously been published. This study compares recall rates with 2D mammography with and without concurrent DBT in women in their forties with a family history of breast cancer undergoing incident screening. MATERIALS AND METHODS: Asymptomatic women aged 40-49 who had previously undergone mammography for an increased risk of breast cancer were recruited in two screening centres. Participants were randomised to screening with 2D mammography only at the first study screen followed a year later by screening with 2D plus DBT, or vice versa. Recall rates were compared using an intention to treat analysis. Reading performance was analysed for the larger centre. RESULTS: 1227 women were recruited. 1221 first screens (604 2D, 617 2D+DBT) and 1124second screens (558 2D+DBT, 566 2D) were analysed. Eleven women had screen-detected cancers: 5 after 2D, 6 after 2D+DBT. The false positive recall rates were 2.4% for 2D and 2.2% for 2D+DBT (p=0.89). There was a significantly greater reduction between rounds in the number of women with abnormal reads who were not recalled after consensus/arbitration with 2D+DBT than 2D (p=0.023). CONCLUSION: The addition of DBT to 2D mammography in incident screening did not lead to a significant reduction in recall rate. DBT may increase reader uncertainty until DBT screening experience is acquired.
Authors: Ilana B Richman; Jessica B Long; Jessica R Hoag; Akhil Upneja; Regina Hooley; Xiao Xu; Natalia Kunst; Jenerius A Aminawung; Kelly A Kyanko; Susan H Busch; Cary P Gross Journal: J Natl Cancer Inst Date: 2021-11-02 Impact factor: 11.816