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Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium

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Abstract

Digital breast tomosynthesis (DBT) is emerging as the new standard of care for breast cancer screening based on improved cancer detection coupled with reductions in recall compared to screening with digital mammography (DM) alone. However, many prior studies lack follow-up data to assess false negatives examinations. The purpose of this study is to assess if DBT is associated with improved screening outcomes based on follow-up data from tumor registries or pathology. Retrospective analysis of prospective cohort data from three research centers performing DBT screening in the PROSPR consortium from 2011 to 2014 was performed. Recall and biopsy rates were assessed from 198,881 women age 40–74 years undergoing screening (142,883 DM and 55,998 DBT examinations). Cancer, cancer detection, and false negative rates and positive predictive values were assessed on examinations with one year of follow-up. Logistic regression was used to compare DBT to DM adjusting for research center, age, prior breast imaging, and breast density. There was a reduction in recall with DBT compared to DM (8.7 vs. 10.4 %, p < 0.0001), with adjusted OR = 0.68 (95 % CI = 0.65–0.71). DBT demonstrated a statistically significant increase in cancer detection over DM (5.9 vs. 4.4/1000 screened, adjusted OR = 1.45, 95 % CI = 1.12–1.88), an improvement in PPV1 (6.4 % for DBT vs. 4.1 % for DM, adjusted OR = 2.02, 95 % CI = 1.54–2.65), and no significant difference in false negative rates for DBT compared to DM (0.46 vs. 0.60/1000 screened, p = 0.347). Our data support implementation of DBT screening based on increased cancer detection, reduced recall, and no difference in false negative screening examinations.

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Abbreviations

BI-RADS:

Breast imaging-reporting and data system

CI:

Confidence interval

DBT:

Digital breast tomosynthesis

D-BWH:

Dartmouth–Hitchcock health system in New Hampshire and Brigham and Women’s Hospital in Massachusetts

DM:

Digital mammography

GEE:

Generalized estimating equations

NCI:

National Cancer Institute

OR:

Odds ratio

PPV1:

Positive predictive value

PROSPR:

Population-based research optimizing screening through personalized regimens

UPenn:

University of Pennsylvania

US:

United States

VT:

University of Vermont

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Acknowledgments

The authors thank the participating PROSPR Research Centers for the data they have provided for this study. A list of the PROSPR investigators and contributing research staff are provided at: http://healthcaredelivery.cancer.gov/prospr/.

Author contributions

Dr. Conant had full access to all the data in the study and takes responsibility for the integrity.

Funding

This work was supported by the National Cancer Institute (NCI)-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium (Grant numbers U01CA163304 to M.T., W.B.; U54CA163303 and P01 CA154292 to D.L.W., B.S., S.H.; U54CA163307 to A.N.A.T., T.O., J.H.; U54CA163313 to E.F.C., K.A., M.S.)

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Authors and Affiliations

  1. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Emily F. Conant & Mitchell D. Schnall

  2. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Elisabeth F. Beaber

  3. Department of Surgery, University of Vermont, Burlington, VT, USA

    Brian L. Sprague

  4. University of Vermont Cancer Center, Burlington, VT, USA

    Brian L. Sprague, Sally D. Herschorn & Donald L. Weaver

  5. Department of Radiology, University of Vermont, Burlington, VT, USA

    Sally D. Herschorn

  6. Department of Pathology, University of Vermont, Burlington, VT, USA

    Donald L. Weaver

  7. Department of Community and Family Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

    Tracy Onega & Anna N. A. Tosteson

  8. Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

    Tracy Onega & Anna N. A. Tosteson

  9. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Anne Marie McCarthy & Katrina Armstrong

  10. Mallinckrodt Institute of Radiology, Washington University of St. Louis, St. Louis, MO, USA

    Steven P. Poplack

  11. Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA

    Jennifer S. Haas

  12. Cancer Research and Biostatistics, Seattle, WA, USA

    William E. Barlow

Authors
  1. Emily F. Conant
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  2. Elisabeth F. Beaber
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  3. Brian L. Sprague
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  4. Sally D. Herschorn
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  5. Donald L. Weaver
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  6. Tracy Onega
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  7. Anna N. A. Tosteson
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  8. Anne Marie McCarthy
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  9. Steven P. Poplack
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  10. Jennifer S. Haas
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  11. Katrina Armstrong
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  12. Mitchell D. Schnall
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  13. William E. Barlow
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Corresponding author

Correspondence to Emily F. Conant.

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Conflicts of interest

Author E.F.C. is a consultant and has been a lecturer for Hologic, Inc., Bedford MA and Siemen’s Healthcare. Author S.P.P. has been renumerated for participating as a reader for Biomedical Systems, St. Louis, MO. Author S.D.H. holds stock in Hologic, Inc. Bedford, MA. Author K.A. is a consultant to GlaxoSmithKline, Philadelphia, PA.

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On behalf of the PROSPR consortium.

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Conant, E.F., Beaber, E.F., Sprague, B.L. et al. Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium. Breast Cancer Res Treat 156, 109–116 (2016). https://doi.org/10.1007/s10549-016-3695-1

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  • DOI: https://doi.org/10.1007/s10549-016-3695-1

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