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Jögi A, Johnson K, Wittgren S, Sundgren V, Tomic H, Olinder J, Åkesson A, Andersson I, Zackrisson S, Bakic PR. Assessing Digital Breast Tomosynthesis Impact on Early Cancer Detection: Insights from Consecutive Screening. Radiology 2024; 312:e233417. [PMID: 39078298 DOI: 10.1148/radiol.233417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Background Analysis of how digital breast tomosynthesis (DBT) screening affects consecutive screening performance is important to estimate its future value in screening. Purpose To evaluate whether DBT contributes to early detection of breast cancer by assessing cancer detection rates (CDRs), including the fraction of invasive cancers and cancer subtypes in consecutive routine digital mammography (DM). Materials and Methods The paired prospective Malmö Breast Tomosynthesis Screening Trial (MBTST) was performed between January 2010 and February 2015. Participating women underwent one-view DBT and two-view DM at one screening occasion. In this secondary analysis, women were followed up through their first (DM1) and second (DM2) consecutive two-view DM screening rounds after MBTST participation. Cancer diagnoses were identified by referencing records. A logistic regression model, adjusted for age, was used to calculate the odds of luminal A-like cancers with use of the MBTST as reference. Results There were 14 848 final participants in the MBTST (median age, 57 years [IQR, 49-65 years]). Of those, 12 876 women were screened in DM1 (median age, 58 years [IQR, 50-66 years]) and 10 883 were screened in DM2 (median age, 59 years [IQR, 51-67 years]). Compared with CDRs in the trial of 6.5 of 1000 women (95% CI: 5.2, 7.9) for DM and 8.7 of 1000 women (95% CI: 7.3, 10.3) for DBT, the CDR was lower in DM1 (4.6 of 1000 women [95% CI: 3.6, 5.9]) and DM2 (5.3 of 1000 women [95% CI: 4.1, 6.9]). The proportion of invasive cancers was 84.9% (118 of 139 cancers) in the MBTST; the corresponding numbers were 66% (39 of 59 cancers) for DM1 and 83% (50 of 60 cancers) for DM2. The odds of luminal A-like cancers were lower in DM1 at 0.28 (95% CI: 0.12, 0.66 [P = .004]) but not in DM2 at 0.80 (95% CI: 0.40, 1.58 [P = .52]) versus screening in the MBTST. Conclusion CDR and the fraction of invasive cancers were lower in DM1 and then increased in DM2 following the MBTST, indicating earlier cancer detection mainly due to increased detection of luminal A-like cancers in DBT screening. Clinical trials registration no. NCT01091545 © RSNA, 2024 See also the editorial by Hooley and Philpotts in this issue.
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Affiliation(s)
- Annika Jögi
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Kristin Johnson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Sofia Wittgren
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Victor Sundgren
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Hanna Tomic
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Jakob Olinder
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Anna Åkesson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Ingvar Andersson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Sophia Zackrisson
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
| | - Predrag R Bakic
- From the Department of Oncology and Radiotherapy, Skåne University Hospital, Klinikgatan 5, 222 42 Lund, Sweden (A.J.); Translational Cancer Research, Department of Laboratory Medicine, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden (A.J.); Radiology Diagnostics, Department of Translational Medicine and Department of Imaging and Physiology (K.J., V.S., H.T., J.O., I.A., S.Z., P.R.B.) and Department of Radiation Physics (P.R.B.), Lund University, Skåne University Hospital; and Department of Imaging and Physiology (K.J., V.S., J.O., I.A., S.Z.) and Department of Rheumatology Lund (S.W.), Lund University Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden (S.W.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Malmö, Sweden (A.Å.)
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Voets MM, Groothuis-Oudshoorn CGM, Veneklaas LHJ, Manohar S, Brinkhuis M, Veltman J, de Munck L, de Geus-Oei LF, Broeders MJM, Siesling S. Diagnostics in Patients Suspect for Breast Cancer in The Netherlands. Curr Oncol 2021; 28:4998-5008. [PMID: 34940058 PMCID: PMC8700505 DOI: 10.3390/curroncol28060419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/23/2022] Open
Abstract
The goal of this study was to describe the variation in hospital-based diagnostic care activities for patients with symptomatology suspect for breast cancer in The Netherlands. Two cohorts were included: the ‘benign’ cohort (30,334 women suspected of, but without breast cancer) and the ‘malignant’ cohort (2236 breast cancer patients). Hospital-based financial data was combined with tumor data (malignant cohort) from The Netherlands Cancer Registry. Patterns within diagnostic pathways were analyzed. Factors influencing the number of visits and number of diagnostic care activities until diagnosis were identified in the malignant cohort with multivariable Cox and Poisson regression models. Compared to patients with benign diagnosis, patients with malignant disease received their diagnosis less frequently in one day, after an equal average number of hospital visits and higher average number of diagnostic activities. Factors increasing the number of diagnostic care activities were the following: lower age and higher cM-and cN-stages. Factors increasing the number of days until (malignant) diagnosis were as follows: higher BIRADS-score, screen-detected and higher cN-and cT-stages. Hospital of diagnosis influenced both number of activities and days to diagnosis. The diagnostic care pathway of patients with malignant disease required more time and diagnostic activities than benign disease and depends on hospital, tumor and patient characteristics.
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Affiliation(s)
- Madelon M. Voets
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (M.M.V.); (C.G.M.G.-O.); (L.H.J.V.)
| | - Catharina G. M. Groothuis-Oudshoorn
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (M.M.V.); (C.G.M.G.-O.); (L.H.J.V.)
| | - Liset H. J. Veneklaas
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (M.M.V.); (C.G.M.G.-O.); (L.H.J.V.)
| | - Srirang Manohar
- Multi-Modality Imaging, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands;
| | - Mariël Brinkhuis
- Laboratory for Pathology East Netherlands, LabPON, Boerhaavelaan 59, P.O. Box 516, 7550 AM Hengelo, The Netherlands;
| | - Jeroen Veltman
- Department of Radiology, Ziekenhuisgroep Twente, Zilvermeeuw 1, P.O. Box 7600, 7609 PP Almelo, The Netherlands;
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB Utrecht, The Netherlands;
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands;
- Biomedical Photonic Imaging Group, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Mireille J. M. Broeders
- Dutch Expert Centre for Screening, P.O. Box 6873, 6503 GJ Nijmegen, The Netherlands;
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (M.M.V.); (C.G.M.G.-O.); (L.H.J.V.)
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-(0)53-489-5638 (ext. 7475)
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