Breast Cancer Research and Treatment

, Volume 156, Issue 1, pp 109–116 | Cite as

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

  • Emily F. Conant
  • Elisabeth F. Beaber
  • Brian L. Sprague
  • Sally D. Herschorn
  • Donald L. Weaver
  • Tracy Onega
  • Anna N. A. Tosteson
  • Anne Marie McCarthy
  • Steven P. Poplack
  • Jennifer S. Haas
  • Katrina Armstrong
  • Mitchell D. Schnall
  • William E. Barlow
Clinical trial


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.


Breast cancer screening Mammography Digital breast tomosynthesis 



Breast imaging-reporting and data system


Confidence interval


Digital breast tomosynthesis


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


Digital mammography


Generalized estimating equations


National Cancer Institute


Odds ratio


Positive predictive value


Population-based research optimizing screening through personalized regimens


University of Pennsylvania


United States


University of Vermont



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:

Author contributions

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


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.)

Compliance with ethical standards

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.


  1. 1.
    Sechopoulos I (2013) A review of breast tomosynthesis. Part I. The image acquisition process. Med Phys 40(1):014301CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Sechopoulos I (2013) A review of breast tomosynthesis. Part II., Image reconstruction, processing and analysis, and advanced applications. Med Phys 40(1):014302CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Niklason LT, Christian BT, LE Niklason (1997) Digital tomosynthesis in breast imaging. Radiology 205.2:399–406CrossRefGoogle Scholar
  4. 4.
    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):47–56CrossRefPubMedGoogle Scholar
  5. 5.
    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):583–589CrossRefPubMedGoogle Scholar
  6. 6.
    Rose SL, Tidwell AL, Bujnoch LJ et al (2013) Implementation of breast tomosynthesis in a routine screening practice: an observational study. AJR Am J Roentgenol 200(6):1401–1408CrossRefPubMedGoogle Scholar
  7. 7.
    Friedewald SM, Rafferty EA, Rose SL et al (2014) Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 311(24):2499–2507CrossRefPubMedGoogle Scholar
  8. 8.
    McCarthy AM, Kontos D, Synnestvedt M (2014) Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program. J Natl Cancer Inst 106(11):dju316CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Durand MA, Haas BM, Xiapan Y (2014) Early clinical experience with digital breast tomosynthesis for screening mammography. Radiology 274:1313–1319Google Scholar
  10. 10.
    Lourenco AP, Barry-Brooks M, Baird GL, Tuttle A, Mainiero MB (2014) Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology 274:1403–1417Google Scholar
  11. 11.
    Haas BM, Kalr V, Geisel J et al (2013) Comparison of tomosynthesis plus digital mammography and digital mammography alone for breast cancer screening. Radiology 269(3):694–700CrossRefPubMedGoogle Scholar
  12. 12.
  13. 13.
    Onego T, Beaber EF, Sprague BL et al (2014) Breast cancer screening in an era of personalized regimens: a conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level. Cancer 120(19):2955–2964CrossRefGoogle Scholar
  14. 14.
    D’Orsi CJ, Bassett LW, Berg WA, et al, (2003) BI-RADS: Mammography, 4th edition. In: D’Orsi CJ, Mendelson EB, Ikeda DM, et al: Breast imaging reporting and data system: ACR BI-RADS—breast Imaging Atlas. Reston, VA: American College of Radiology;Google Scholar
  15. 15.
  16. 16.
    Houssami N, Macaskill P, Bernardi D et al (2014) Breast screening using 2D-mammography or integrating digital breast tomosynthesis (3D-mammography) for single-reading or double-reading—evidence to guide future screening strategies. Eur J Cancer 50(10):1799–1807CrossRefPubMedGoogle Scholar
  17. 17.
    Houssami N, Abraham LA, Kerlikowske K (2013) Risk factors for second screen-detected or interval breast cancers in women with a personal history of breast cancer participating in mammography screening. Cancer Epidemiol Biomarkers Prev 22:946–961CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    McDonald ES, Oustimov A, Weinstein SP, Synnestvedt M, Schnall M, Conant EF (2016) Effectiveness of digital breast tomosynthesis compared with digital mammography: Outcomes analysis from 3 years of breast cancer screening. JAMA Onc. doi: 10.001/jamaoncol.2015.5536

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Emily F. Conant
    • 1
  • Elisabeth F. Beaber
    • 2
  • Brian L. Sprague
    • 3
    • 4
  • Sally D. Herschorn
    • 4
    • 5
  • Donald L. Weaver
    • 4
    • 6
  • Tracy Onega
    • 7
    • 8
  • Anna N. A. Tosteson
    • 7
    • 8
  • Anne Marie McCarthy
    • 9
  • Steven P. Poplack
    • 10
  • Jennifer S. Haas
    • 11
  • Katrina Armstrong
    • 9
  • Mitchell D. Schnall
    • 1
  • William E. Barlow
    • 12
  1. 1.Department of Radiology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleUSA
  3. 3.Department of SurgeryUniversity of VermontBurlingtonUSA
  4. 4.University of Vermont Cancer CenterBurlingtonUSA
  5. 5.Department of RadiologyUniversity of VermontBurlingtonUSA
  6. 6.Department of PathologyUniversity of VermontBurlingtonUSA
  7. 7.Department of Community and Family Medicine and The Dartmouth Institute for Health Policy and Clinical PracticeGeisel School of Medicine at DartmouthLebanonUSA
  8. 8.Norris Cotton Cancer CenterGeisel School of Medicine at DartmouthLebanonUSA
  9. 9.Department of MedicineMassachusetts General HospitalBostonUSA
  10. 10.Mallinckrodt Institute of RadiologyWashington University of St. LouisSt. LouisUSA
  11. 11.Division of General Internal Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  12. 12.Cancer Research and BiostatisticsSeattleUSA

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