Screening outcome for consecutive examinations with digital breast tomosynthesis versus standard digital mammography in a population-based screening program

  • Tone Hovda
  • Siri H. B. Brandal
  • Sofie Sebuødegård
  • Åsne S. Holen
  • Hilde Bjørndal
  • Per Skaane
  • Solveig HofvindEmail author



To retrospectively investigate early performance measures of digital breast tomosynthesis (DBT) versus standard digital mammography (DM) for consecutive screening rounds.


We included information about 35,736 women screened in BreastScreen Norway, 2008–2016, with at least two consecutive screening examinations. The pair of two consecutive screening examinations was the unit of analysis, and results from the subsequent examination were the measure of interest. Screening technique changed during the study period, resulting in four study groups: DM after DM, DBT after DM, DM after DBT, and DBT after DBT. We compared selected early performance measures between the study groups.


Recall for DM after DM was 3.6% and lower for all other study groups (p < 0.001). The rate of screen-detected breast cancer was 4.6/1000 for DM after DM; for DBT after DM and DBT after DBT, it was 9.9/1000 and 8.3/1000, respectively (p < 0.001 relative to DM after DM), and for DM after DBT 4.3/1000. The rate of tubular carcinoma was higher for DBT after DBT or after DM compared with DM after DM (p < 0.01). The rate of histologic grade 1 tumors was higher for DBT after DM compared with DM after DM (p < 0.001). We did not observe any statistical difference in the interval cancer rates.


Lower recall and higher cancer detection rates for screening with DBT were sustainable over two consecutive screening rounds. Positive predictive values were higher for DBT than DM. There were no differences in the interval cancer rates between the study groups.

Key Points

• There is limited knowledge about early performance measures for screening with digital breast tomosynthesis beyond one screening round.

• A decline in recall rate and an incline in the rate of screen-detected breast cancer were observed for women screened with DBT compared with DM, irrespective of prior screening technique. The interval breast cancer rate did not differ statistically for women screened with DBT versus DM.

• Tumor characteristics tended to be prognostic favorable for DBT compared with DM with no differences in rates of more advanced cancers. The clinical significance of increased cancer detection and the potential for future mortality reduction remain unknown.


Screening Breast neoplasm Digital breast tomosynthesis Mammography Digital mammography 





Digital breast tomosynthesis


Ductal carcinoma in situ


Digital mammography


Estrogen receptor


False negative


False positive


Human epidermal growth factor receptor 2


Invasive ductal carcinoma


Invasive lobular carcinoma


Invasive tubular carcinoma


Mediolateral oblique


Oslo Tomosynthesis Screening Trial


Oslo-Vestfold-Vestre Viken study


Positive predictive value


Progesterone receptor


Synthetic mammogram


Screening with Tomosynthesis OR standard Mammography


True negative


True positive



Vestre Viken Health Trust partially funded the salary for TH during the project period. Planning of the study and the analyses were not related to this funding, and the health trust did not contribute academically to the study. SH is the Head of BreastScreen Norway


The authors state that this work has not received any funding for running the study.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Solveig Hofvind.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. SH is the Head of BreastScreen Norway, but has permanent employment as a researcher at the Cancer Registry of Norway, independent of her job as administrative leader of BreastScreen Norway.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

The Cancer Registry Regulation gives approval with waiver of informed consent to perform surveillance, quality assurance, and studies based on data collected as a part of invitation to and participation in the program.

Ethical approval

Institutional Review Board approval was obtained. Data was collected from BreastScreen Norway and thus covered by the Cancer Registry Regulation. Data from the Oslo Tomosynthesis Study Trial, as a part of BreastScreen Norway, was also approved by the regional ethical committee and data from the Oslo-Vestre-Viken-Vestfold study was approved by the institutional Data Protection Officer.

Study subjects or cohorts overlap

Some study subjects or cohorts have been included in previously published papers—the Oslo Tomosynthesis Trial and the Oslo-Vestfold-VestreViken study.

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 267:47–56.

Hofvind S, Hovda T, Holen ÅS et al (2018) Digital Breast Tomosynthesis and Synthetic 2D Mammography versus Digital Mammography: Evaluation in a Population-based Screening Program. Radiology.


• Retrospective

• Observational

• Performed at one institution

Supplementary material

330_2019_6264_MOESM1_ESM.docx (34 kb)
ESM 1 (DOCX 33 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyVestre Viken HospitalDrammenNorway
  2. 2.Division of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
  3. 3.Cancer Registry of NorwayOsloNorway
  4. 4.Oslo Metropolitan University, Faculty of Health ScienceOsloNorway

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