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Lee JM, Ichikawa LE, Wernli KJ, Bowles E, Specht JM, Kerlikowske K, Miglioretti DL, Lowry KP, Tosteson ANA, Stout NK, Houssami N, Onega T, Buist DSM. Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007-2016. Radiology 2021; 300:290-300. [PMID: 34003059 PMCID: PMC8328154 DOI: 10.1148/radiol.2021204581] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 01/13/2023]
Abstract
Background Since 2007, digital mammography and digital breast tomosynthesis (DBT) replaced screen-film mammography. Whether these technologic advances have improved diagnostic performance has, to the knowledge of the authors, not yet been established. Purpose To evaluate the performance and outcomes of surveillance mammography (digital mammography and DBT) performed from 2007 to 2016 in women with a personal history of breast cancer and compare with data from 1996 to 2007 and the performance of digital mammography screening benchmarks. Materials and Methods In this observational cohort study, five Breast Cancer Surveillance Consortium registries provided prospectively collected mammography data linked with tumor registry and pathologic outcomes. This study identified asymptomatic women with American Joint Committee on Cancer anatomic stages 0-III primary breast cancer who underwent surveillance mammography from 2007 to 2016. The primary outcome was a second breast cancer diagnosis within 1 year of mammography. Performance measures included the recall rate, cancer detection rate, interval cancer rate, positive predictive value of biopsy recommendation, sensitivity, and specificity. Results Among 32 331 women who underwent 117 971 surveillance mammographic examinations (112 269 digital mammographic examinations and 5702 DBT examinations), the mean age at initial diagnosis was 59 years ± 12 (standard deviation). Of 1418 second breast cancers diagnosed, 998 were surveillance-detected cancers and 420 were interval cancers. The recall rate was 8.8% (10 365 of 117 971; 95% CI: 8.6%, 9.0%), the cancer detection rate was 8.5 per 1000 examinations (998 of 117 971; 95% CI: 8.0, 9.0), the interval cancer rate was 3.6 per 1000 examinations (420 of 117 971; 95% CI: 3.2, 3.9), the positive predictive value of biopsy recommendation was 31.0% (998 of 3220; 95% CI: 29.4%, 32.7%), the sensitivity was 70.4% (998 of 1418; 95% CI: 67.9%, 72.7%), and the specificity was 98.1% (114 331 of 116 553; 95% CI: 98.0%, 98.2%). Compared with previously published studies, interval cancer rate was comparable with rates from 1996 to 2007 in women with a personal history of breast cancer and was higher than the published digital mammography screening benchmarks. Conclusion In transitioning from screen-film to digital mammography and digital breast tomosynthesis, surveillance mammography performance demonstrated minimal improvement over time and remained inferior to the performance of screening mammography benchmarks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Moy and Gao in this issue.
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Affiliation(s)
- Janie M. Lee
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Laura E. Ichikawa
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Karen J. Wernli
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Erin Bowles
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Jennifer M. Specht
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Karla Kerlikowske
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Diana L. Miglioretti
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Kathryn P. Lowry
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Anna N. A. Tosteson
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Natasha K. Stout
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Nehmat Houssami
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Tracy Onega
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Diana S. M. Buist
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
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