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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Tabár L, Vitak B, Chen TH et al (2011) Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades. Radiology 260(3):658–663
U.S. Preventive Services Task Force (2009) Screening for breast cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med 151:716–726
Lauby-Secretan B, Scoccianti C, Loomis D et al (2015) Breast-cancer screening—viewpoint of the IARC Working Group. N Engl J Med 372(24):2353–2358
Siu AL, US Preventative Task Force (2016) Screening for breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 164(4):279–296
Oeffinger K, Fontham E, Etzioni R et al (2015) Breast cancer screening for women at average risk: 2015 Guideline update from the American Cancer Society. JAMA 314:1599–1614
Skaane P, Bandos AI, Gullien R et al (2013) Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology 267(1):47–56
Ciatto S, Houssami N, Bernardi D et al (2013) Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 14(7):583–589
Rose SL, Tidwell AL, Bujnoch LJ, Kushwaha AC, Nordmann AS, Sexton R Jr (2013) Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol 200(6):1401–1408
Haas BM, Kalra V, Geisel J, Raghu M, Durand M, Philpotts LE (2013) Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology 269(3):694–700
McCarthy AM, Kontos D, Synnestvedt M et al (2014) Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program. J Natl Cancer Inst 106(11):dju316
Lång K, Andersson I, Rosso A, Tingberg A, Timberg P, Zackrisson S (2016) Performance of one-view breast tomosynthesis as a stand-alone breast cancer screening modality: results from the malmö breast tomosynthesis screening trial, a population-based study. Eur Radiol 26(1):184–190
Friedewald SM, Rafferty EA, Rose SL et al (2014) Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 311(24):2499–2507
Rafferty EA, Durand MA, Conant EF et al (2016) Breast cancer screening using tomosynthesis and digital mammography in dense and non-dense breasts. JAMA 315(16):1784–1786
Broeders M, Moss S, Nystrom L, EUROSCREEN Working Group et al (2012) The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies. J Med Screen 19(suppl 1):14–25
Gotzche PC, Jorgensen KJ (2013) Screening for breast cancer with mammography. Cochrane Database Syst Rev 6:CD001877
Berry DA, Cronin KA, Plevritis SK, Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators et al (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353(17):1784–1792
Funding
Elizabeth A. Rafferty, Stephen L. Rose, Melissa A. Durand, Debra Somers Copit, Sarah M. Friedewald, Donna M. Plecha, Ingrid L. Ott, Mary K. Hayes, Kara L. Carlson, Thomas M. Cink, Lora D. Barke, and Linda N. Greer received a research Grant from Hologic, Inc. Emily F. Conant received a research grant 5U54CA163316-03 from the National Cancer Institute.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Dr. Rafferty, Dr. Rose, and Mr. Miller are consultants to Hologic, Inc. Drs. Friedewald, Plecha, Hayes, and Greer are consultants to Hologic, Inc. and on the Hologic, Inc. Scientific Advisory Board. Drs. Conant, Copit, and Carlson are on the Hologic, Inc. Scientific Advisory Board. Dr. Cink is Board Member Wellmark Blue Cross/Blue Shield for Iowa and South Dakota. Dr. Niklason is a former employee of Hologic, Inc., now retired.
Rights and permissions
About this article
Cite this article
Rafferty, E.A., Rose, S.L., Miller, D.P. et al. Effect of age on breast cancer screening using tomosynthesis in combination with digital mammography. Breast Cancer Res Treat 164, 659–666 (2017). https://doi.org/10.1007/s10549-017-4299-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-017-4299-0