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Lee H. Integrating Clinical Workflow for Breast Cancer Screening with AI. Radiol Artif Intell 2024; 6:e240532. [PMID: 39259021 DOI: 10.1148/ryai.240532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Affiliation(s)
- Hoyeon Lee
- From the Department of Diagnostic Radiology and Centre of Cancer Medicine, University of Hong Kong, Hong Kong
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Philpotts LE, Grewal JK, Horvath LJ, Giwerc MY, Staib L, Etesami M. Breast Cancers Detected during a Decade of Screening with Digital Breast Tomosynthesis: Comparison with Digital Mammography. Radiology 2024; 312:e232841. [PMID: 39287520 DOI: 10.1148/radiol.232841] [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: 09/19/2024]
Abstract
Background Digital breast tomosynthesis (DBT) has been shown to help increase cancer detection compared with two-dimensional digital mammography (DM). However, it is unclear whether additional tumor detection will improve outcomes or lead to overdiagnosis of breast cancer. Purpose This study aimed to compare cancer types and stages over 3 years of DM screening and 10 years of DBT screening to determine the effect of DBT. Materials and Methods A retrospective search identified breast cancers detected by using screening mammography from August 2008 through July 2021. Data collected included demographic, imaging, and pathologic information. Invasive cancers 2 cm or larger, human epidermal growth factor 2-positive or triple-negative tumors greater than 10 mm, axillary nodes positive for cancer, and distant organ spread were considered advanced cancers. The DBT and DM cohorts were compared and further analyzed by prevalent versus incident examinations. False-negative findings were also assessed. Results A total of 1407 breast cancers were analyzed (142 with DM, 1265 with DBT). DBT showed a higher rate of cancer depiction than DM (5.3 vs four cancers per 1000, respectively; P = .001), with a similar ratio of invasive cancers to ductal carcinomas in situ (76.5%:23.5% [968 and 297 of 1265, respectively] vs 71.1%:28.9% [101 and 41 of 142, respectively]). Mean invasive cancer size did not differ between DM and DBT (1.44 cm ± 0.93 [SD] vs 1.36 cm ± 1.14, respectively; P = .49), but incident DBT cases were smaller than prevalent cases (1.2 cm ± 1.0 vs 1.6 cm ± 1.4, respectively; P < .001). DBT and DM had similar rates of invasive cancer subtypes: low grade (26.5% [243 of 912] vs 29% [28 of 96], respectively), moderate grade (57.2% [522 of 912] vs 51% [49 of 96], respectively), and high grade (16.1% [147 of 912] vs 20% [19 of 96], respectively) (P = .65). The proportion of advanced cancers was lower with DBT than DM (32.6% [316 of 968] vs 43.6% [44 of 101], respectively; P = .04) and between DBT prevalent and incident screening (39.1% [133 of 340] vs 29.1% [183 of 628], respectively; P = .003). There was no difference in interval cancer rates (0.14 per 1000 with DM and 0.2 per 1000 with DBT; P = .42) for both groups. Conclusion DBT helped to increase breast cancer detection rate and depicted invasive cancers with a lower rate of advanced cancers compared with DM, with further improvement observed at incident rounds of screening. © RSNA, 2024 See also the editorial by Kim and Woo in this issue.
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Affiliation(s)
- Liane Elizabeth Philpotts
- From the Department of Radiology and Biomedical Imaging (L.E.P., L.J.H., L.S., M.E.) and Yale Physician Associate Program, Internal Medicine (J.K.G., M.Y.G.), Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06520
| | - Jaskirandeep Kaur Grewal
- From the Department of Radiology and Biomedical Imaging (L.E.P., L.J.H., L.S., M.E.) and Yale Physician Associate Program, Internal Medicine (J.K.G., M.Y.G.), Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06520
| | - Laura Jean Horvath
- From the Department of Radiology and Biomedical Imaging (L.E.P., L.J.H., L.S., M.E.) and Yale Physician Associate Program, Internal Medicine (J.K.G., M.Y.G.), Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06520
| | - Michelle Young Giwerc
- From the Department of Radiology and Biomedical Imaging (L.E.P., L.J.H., L.S., M.E.) and Yale Physician Associate Program, Internal Medicine (J.K.G., M.Y.G.), Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06520
| | - Lawrence Staib
- From the Department of Radiology and Biomedical Imaging (L.E.P., L.J.H., L.S., M.E.) and Yale Physician Associate Program, Internal Medicine (J.K.G., M.Y.G.), Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06520
| | - Maryam Etesami
- From the Department of Radiology and Biomedical Imaging (L.E.P., L.J.H., L.S., M.E.) and Yale Physician Associate Program, Internal Medicine (J.K.G., M.Y.G.), Yale School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06520
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Djuric O, Deandrea S, Mantellini P, Sardanelli F, Venturelli F, Montemezzi S, Vecchio R, Bucchi L, Senore C, Giordano L, Paci E, Bonifacino A, Calabrese M, Caumo F, Degrassi F, Sassoli De' Bianchi P, Battisti F, Zappa M, Pattacini P, Campari C, Nitrosi A, Di Leo G, Frigerio A, Magni V, Fornasa F, Romanucci G, Falini P, Auzzi N, Armaroli P, Giorgi Rossi P. Budget impact analysis of introducing digital breast tomosynthesis in breast cancer screening in Italy. LA RADIOLOGIA MEDICA 2024; 129:1288-1302. [PMID: 39162938 DOI: 10.1007/s11547-024-01850-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/04/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE This study quantifies the impact on budget and cost per health benefit of implementing digital breast tomosynthesis (DBT) in place of digital mammography (DM) for breast cancer screening among asymptomatic women in Italy. METHODS A budget impact analysis and a cost consequence analysis were conducted using parameters from the MAITA project and literature. The study considered four scenarios for DBT implementation, i.e., DBT for all women, DBT for women aged 45-49 years, DBT based on breast density (BI-RADS C + D or D only), and compared these to the current DM screening. Healthcare provider's perspective was adopted, including screening, diagnosis, and cancer treatment costs. RESULTS Introducing DBT for all women would increase overall screening costs by 20%. Targeting DBT to women aged 45-49 years or with dense breasts would result in smaller cost increases (3.2% for age-based and 1.4-10.7% for density-based scenarios). The cost per avoided interval cancer was significantly higher when DBT was applied to all women compared to targeted approaches. The cost per gained early-detected cancer slightly increases in targeted approaches, while the assumptions on the clinical significance and overdiagnosis of cancers detected by DBT and not by DM have a strong impact. CONCLUSIONS Implementing DBT as a primary breast cancer test in screening programs in Italy would lead to a substantial increase in costs. Tailoring DBT use to women aged 45-49 or with dense breasts could enhance the feasibility and sustainability of the intervention. Further research is needed to clarify the impact of DBT on overdiagnosis and the long-term outcomes.
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Affiliation(s)
- Olivera Djuric
- Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paola Mantellini
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | | | | | | | | | - Lauro Bucchi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRST S.r.l., Meldola, Forlì-Cesena, Italy
| | - Carlo Senore
- AOU Città della Salute e della Scienza- CPO Piemonte Torino, Turin, Italy
| | - Livia Giordano
- AOU Città della Salute e della Scienza- CPO Piemonte Torino, Turin, Italy
| | | | | | | | | | - Flori Degrassi
- Associazione Nazionale Donne Operate al Seno - ANDOS, Milan, Italy
| | | | - Francesca Battisti
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | - Marco Zappa
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | | | - Cinzia Campari
- Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Nitrosi
- Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Di Leo
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alfonso Frigerio
- AOU Città della Salute e della Scienza- CPO Piemonte Torino, Turin, Italy
| | - Veronica Magni
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Francesca Fornasa
- Breast Unit ULSS9 Scaligera, Ospedale Fracastoro, San Bonifacio, Verona, Italy
| | - Giovanna Romanucci
- Breast Unit ULSS9 Scaligera, Ospedale Fracastoro, San Bonifacio, Verona, Italy
| | - Patrizia Falini
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | - Noemi Auzzi
- ISPRO - Istituto per lo Studio, la Prevenzione e la Rete Oncologica, Florence, Italy
| | - Paola Armaroli
- AOU Città della Salute e della Scienza- CPO Piemonte Torino, Turin, Italy
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Stout NK, Miglioretti DL, Su YR, Lee CI, Abraham L, Alagoz O, de Koning HJ, Hampton JM, Henderson L, Lowry KP, Mandelblatt JS, Onega T, Schechter CB, Sprague BL, Stein S, Trentham-Dietz A, van Ravesteyn NT, Wernli KJ, Kerlikowske K, Tosteson ANA. Breast Cancer Screening Using Mammography, Digital Breast Tomosynthesis, and Magnetic Resonance Imaging by Breast Density. JAMA Intern Med 2024:2822381. [PMID: 39186304 PMCID: PMC11348087 DOI: 10.1001/jamainternmed.2024.4224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/01/2024] [Indexed: 08/27/2024]
Abstract
Importance Information on long-term benefits and harms of screening with digital breast tomosynthesis (DBT) with or without supplemental breast magnetic resonance imaging (MRI) is needed for clinical and policy discussions, particularly for patients with dense breasts. Objective To project long-term population-based outcomes for breast cancer mammography screening strategies (DBT or digital mammography) with or without supplemental MRI by breast density. Design, Setting, and Participants Collaborative modeling using 3 Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer simulation models informed by US Breast Cancer Surveillance Consortium data. Simulated women born in 1980 with average breast cancer risk were included. Modeling analyses were conducted from January 2020 to December 2023. Intervention Annual or biennial mammography screening with or without supplemental MRI by breast density starting at ages 40, 45, or 50 years through age 74 years. Main outcomes and Measures Lifetime breast cancer deaths averted, false-positive recall and false-positive biopsy recommendations per 1000 simulated women followed-up from age 40 years to death summarized as means and ranges across models. Results Biennial DBT screening for all simulated women started at age 50 vs 40 years averted 7.4 vs 8.5 breast cancer deaths, respectively, and led to 884 vs 1392 false-positive recalls and 151 vs 221 false-positive biopsy recommendations, respectively. Biennial digital mammography had similar deaths averted and slightly more false-positive test results than DBT screening. Adding MRI for women with extremely dense breasts to biennial DBT screening for women aged 50 to 74 years increased deaths averted (7.6 vs 7.4), false-positive recalls (919 vs 884), and false-positive biopsy recommendations (180 vs 151). Extending supplemental MRI to women with heterogeneously or extremely dense breasts further increased deaths averted (8.0 vs 7.4), false-positive recalls (1088 vs 884), and false-positive biopsy recommendations (343 vs 151). The same strategy for women aged 40 to 74 years averted 9.5 deaths but led to 1850 false-positive recalls and 628 false-positive biopsy recommendations. Annual screening modestly increased estimated deaths averted but markedly increased estimated false-positive results. Conclusions and relevance In this model-based comparative effectiveness analysis, supplemental MRI for women with dense breasts added to DBT screening led to greater benefits and increased harms. The balance of this trade-off for supplemental MRI use was more favorable when MRI was targeted to women with extremely dense breasts who comprise approximately 10% of the population.
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Affiliation(s)
- Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Diana L. Miglioretti
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Christoph I. Lee
- Fred Hutchinson Cancer Center, University of Washington School of Medicine, Seattle
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering and Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin–Madison, Madison
| | - Harry J. de Koning
- Department of Public Health, Erasmus University Medical Center Rotterdam, the Netherlands
| | - John M. Hampton
- Department of Industrial and Systems Engineering and Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin–Madison, Madison
| | - Louise Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kathryn P. Lowry
- Fred Hutchinson Cancer Center University of Washington School of Medicine, Seattle
| | - Jeanne S. Mandelblatt
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Department of Oncology and Georgetown Lombardi Institute for Cancer and Aging REsearch (I-CARE), Georgetown University, Washington, DC
| | - Tracy Onega
- Department of Population Health Sciences, and the Huntsman Cancer Institute, University of Utah, Salt Lake City
| | - Clyde B. Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Brian L. Sprague
- Department of Surgery, University of Vermont Cancer Center, Burlington, Vermont
- University of Vermont Larner College of Medicine, Burlington
- Department of Radiology, University of Vermont Cancer Center, Burlington, Vermont
| | - Sarah Stein
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin–Madison, Madison
| | | | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Departments of Medicine and of Community and Family Medicine, and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Patel MM, Adrada BE. Hereditary Breast Cancer: BRCA Mutations and Beyond. Radiol Clin North Am 2024; 62:627-642. [PMID: 38777539 DOI: 10.1016/j.rcl.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Hereditary breast cancers are manifested by pathogenic and likely pathogenic genetic mutations. Penetrance expresses the breast cancer risk associated with these genetic mutations. Although BRCA1/2 are the most widely known genetic mutations associated with breast cancer, numerous additional genes demonstrate high and moderate penetrance for breast cancer. This review describes current genetic testing, details the specific high and moderate penetrance genes for breast cancer and reviews the current approach to screening for breast cancer in patients with these genetic mutations.
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Affiliation(s)
- Miral M Patel
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA.
| | - Beatriz Elena Adrada
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, CPB5.3208, Houston, TX 77030, USA
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Trentham-Dietz A, Chapman CH, Jayasekera J, Lowry KP, Heckman-Stoddard BM, Hampton JM, Caswell-Jin JL, Gangnon RE, Lu Y, Huang H, Stein S, Sun L, Gil Quessep EJ, Yang Y, Lu Y, Song J, Muñoz DF, Li Y, Kurian AW, Kerlikowske K, O'Meara ES, Sprague BL, Tosteson ANA, Feuer EJ, Berry D, Plevritis SK, Huang X, de Koning HJ, van Ravesteyn NT, Lee SJ, Alagoz O, Schechter CB, Stout NK, Miglioretti DL, Mandelblatt JS. Collaborative Modeling to Compare Different Breast Cancer Screening Strategies: A Decision Analysis for the US Preventive Services Task Force. JAMA 2024; 331:1947-1960. [PMID: 38687505 DOI: 10.1001/jama.2023.24766] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Importance The effects of breast cancer incidence changes and advances in screening and treatment on outcomes of different screening strategies are not well known. Objective To estimate outcomes of various mammography screening strategies. Design, Setting, and Population Comparison of outcomes using 6 Cancer Intervention and Surveillance Modeling Network (CISNET) models and national data on breast cancer incidence, mammography performance, treatment effects, and other-cause mortality in US women without previous cancer diagnoses. Exposures Thirty-six screening strategies with varying start ages (40, 45, 50 years) and stop ages (74, 79 years) with digital mammography or digital breast tomosynthesis (DBT) annually, biennially, or a combination of intervals. Strategies were evaluated for all women and for Black women, assuming 100% screening adherence and "real-world" treatment. Main Outcomes and Measures Estimated lifetime benefits (breast cancer deaths averted, percent reduction in breast cancer mortality, life-years gained), harms (false-positive recalls, benign biopsies, overdiagnosis), and number of mammograms per 1000 women. Results Biennial screening with DBT starting at age 40, 45, or 50 years until age 74 years averted a median of 8.2, 7.5, or 6.7 breast cancer deaths per 1000 women screened, respectively, vs no screening. Biennial DBT screening at age 40 to 74 years (vs no screening) was associated with a 30.0% breast cancer mortality reduction, 1376 false-positive recalls, and 14 overdiagnosed cases per 1000 women screened. Digital mammography screening benefits were similar to those for DBT but had more false-positive recalls. Annual screening increased benefits but resulted in more false-positive recalls and overdiagnosed cases. Benefit-to-harm ratios of continuing screening until age 79 years were similar or superior to stopping at age 74. In all strategies, women with higher-than-average breast cancer risk, higher breast density, and lower comorbidity level experienced greater screening benefits than other groups. Annual screening of Black women from age 40 to 49 years with biennial screening thereafter reduced breast cancer mortality disparities while maintaining similar benefit-to-harm trade-offs as for all women. Conclusions This modeling analysis suggests that biennial mammography screening starting at age 40 years reduces breast cancer mortality and increases life-years gained per mammogram. More intensive screening for women with greater risk of breast cancer diagnosis or death can maintain similar benefit-to-harm trade-offs and reduce mortality disparities.
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Affiliation(s)
- Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Christina Hunter Chapman
- Department of Radiation Oncology and Center for Innovations in Quality, Safety, and Effectiveness, Baylor College of Medicine, Houston, Texas
| | - Jinani Jayasekera
- Health Equity and Decision Sciences (HEADS) Research Laboratory, Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
| | | | - Brandy M Heckman-Stoddard
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | | | - Ronald E Gangnon
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Ying Lu
- Stanford University, Stanford, California
| | - Hui Huang
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sarah Stein
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Liyang Sun
- Stanford University, Stanford, California
| | | | | | - Yifan Lu
- Department of Industrial and Systems Engineering and Carbone Cancer Center, University of Wisconsin-Madison
| | - Juhee Song
- University of Texas MD Anderson Cancer Center, Houston
| | | | - Yisheng Li
- University of Texas MD Anderson Cancer Center, Houston
| | - Allison W Kurian
- Departments of Medicine and Epidemiology and Population Health, Stanford University, Stanford, California
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California San Francisco
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Anna N A Tosteson
- Dartmouth Institute for Health Policy and Clinical Practice and Departments of Medicine and Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Donald Berry
- University of Texas MD Anderson Cancer Center, Houston
| | - Sylvia K Plevritis
- Departments of Biomedical Data Science and Radiology, Stanford University, Stanford, California
| | - Xuelin Huang
- University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Sandra J Lee
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering and Carbone Cancer Center, University of Wisconsin-Madison
| | | | - Natasha K Stout
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Public Health Sciences, University of California Davis
| | - Jeanne S Mandelblatt
- Departments of Oncology and Medicine, Georgetown University Medical Center, and Georgetown Lombardi Comprehensive Institute for Cancer and Aging Research at Georgetown University Lombardi Comprehensive Cancer Center, Washington, DC
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7
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Henderson JT, Webber EM, Weyrich MS, Miller M, Melnikow J. Screening for Breast Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2024; 331:1931-1946. [PMID: 38687490 DOI: 10.1001/jama.2023.25844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Importance Breast cancer is a leading cause of cancer mortality for US women. Trials have established that screening mammography can reduce mortality risk, but optimal screening ages, intervals, and modalities for population screening guidelines remain unclear. Objective To review studies comparing different breast cancer screening strategies for the US Preventive Services Task Force. Data Sources MEDLINE, Cochrane Library through August 22, 2022; literature surveillance through March 2024. Study Selection English-language publications; randomized clinical trials and nonrandomized studies comparing screening strategies; expanded criteria for screening harms. Data Extraction and Synthesis Two reviewers independently assessed study eligibility and quality; data extracted from fair- and good-quality studies. Main Outcomes and Measures Mortality, morbidity, progression to advanced cancer, interval cancers, screening harms. Results Seven randomized clinical trials and 13 nonrandomized studies were included; 2 nonrandomized studies reported mortality outcomes. A nonrandomized trial emulation study estimated no mortality difference for screening beyond age 74 years (adjusted hazard ratio, 1.00 [95% CI, 0.83 to 1.19]). Advanced cancer detection did not differ following annual or biennial screening intervals in a nonrandomized study. Three trials compared digital breast tomosynthesis (DBT) mammography screening with digital mammography alone. With DBT, more invasive cancers were detected at the first screening round than with digital mammography, but there were no statistically significant differences in interval cancers (pooled relative risk, 0.87 [95% CI, 0.64-1.17]; 3 studies [n = 130 196]; I2 = 0%). Risk of advanced cancer (stage II or higher) at the subsequent screening round was not statistically significant for DBT vs digital mammography in the individual trials. Limited evidence from trials and nonrandomized studies suggested lower recall rates with DBT. An RCT randomizing individuals with dense breasts to invitations for supplemental screening with magnetic resonance imaging reported reduced interval cancer risk (relative risk, 0.47 [95% CI, 0.29-0.77]) and additional false-positive recalls and biopsy results with the intervention; no longer-term advanced breast cancer incidence or morbidity and mortality outcomes were available. One RCT and 1 nonrandomized study of supplemental ultrasound screening reported additional false-positives and no differences in interval cancers. Conclusions and Relevance Evidence comparing the effectiveness of different breast cancer screening strategies is inconclusive because key studies have not yet been completed and few studies have reported the stage shift or mortality outcomes necessary to assess relative benefits.
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Affiliation(s)
- Jillian T Henderson
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Portland, Oregon
| | - Meghan S Weyrich
- University of California Davis Center for Healthcare Policy and Research, Sacramento
| | - Marykate Miller
- University of California Davis Center for Healthcare Policy and Research, Sacramento
| | - Joy Melnikow
- University of California Davis Center for Healthcare Policy and Research, Sacramento
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8
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Skaane P, Østerås BH, Yanakiev S, Lie T, Eben EB, Gullien R, Brandal SHB. Discordant and false-negative interpretations at digital breast tomosynthesis in the prospective Oslo Tomosynthesis Screening Trial (OTST) using independent double reading. Eur Radiol 2024; 34:3912-3923. [PMID: 37938385 PMCID: PMC11166849 DOI: 10.1007/s00330-023-10400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/28/2023] [Accepted: 09/15/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To analyze discordant and false-negatives of double reading digital breast tomosynthesis (DBT) versus digital mammography (DM) including reading times in the Oslo Tomosynthesis Screening Trial (OTST), and reclassify these in a retrospective reader study as missed, minimal sign, or true-negatives. METHODS The prospective OTST comparing double reading DBT vs. DM had paired design with four parallel arms: DM, DM + computer aided detection, DBT + DM, and DBT + synthetic mammography. Eight radiologists interpreted images in batches using a 5-point scale. Reading time was automatically recorded. A retrospective reader study including four radiologists classified screen-detected cancers with at least one false-negative score and screening examinations of interval cancers as negative, non-specific minimal sign, significant minimal sign, and missed; the two latter groups are defined "actionable." Statistics included chi-square, Fisher's exact, McNemar's, and Mann-Whitney U tests. RESULTS Discordant rate (cancer missed by one reader) for screen-detected cancers was overall comparable (DBT (31% [71/227]) and DM (30% [52/175]), p = .81), significantly lower at DBT for spiculated cancers (DBT, 19% [20/106] vs. DM, 36% [38/106], p = .003), but high (28/49 = 57%, p = 0.001) for DBT-only detected spiculated cancers. Reading time and sensitivity varied among readers. False-negative DBT-only detected spiculated cancers had shorter reading time than true-negatives in 46% (13/28). Retrospective evaluation classified the following DBT exams "actionable": three missed by both readers, 95% (39/41) of discordant cancers detected by both modes, all 30 discordant DBT-only cancers, 25% (13/51) of interval cancers. CONCLUSIONS Discordant rate was overall comparable for DBT and DM, significantly lower at DBT for spiculated cancers, but high for DBT-only detected spiculated lesions. Most false-negative screen-detected DBT were classified as "actionable." CLINICAL RELEVANCE STATEMENT Retrospective evaluation of false-negative interpretations from the Oslo Tomosynthesis Screening Trial shows that most discordant and several interval cancers could have been detected at screening. This underlines the potential for modern AI-based reading aids and triage, as high-volume screening is a demanding task. KEY POINTS • Digital breast tomosynthesis (DBT) screening is more sensitive and has higher specificity compared to digital mammography screening, but high-volume DBT screening is a demanding task which can result in high discordance rate among readers. • Independent double reading DBT screening had overall comparable discordance rate as digital mammography, lower for spiculated masses seen on both modalities, and higher for small spiculated cancer seen only on DBT. • Almost all discordant digital breast tomosynthesis-detected cancers (72 of 74) and 25% (13 of 51) of the interval cancers in the Oslo Tomosynthesis Screening Trial were retrospectively classified as actionable and could have been detected by the readers.
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Affiliation(s)
- Per Skaane
- Division of Radiology and Nuclear Medicine, Department of Breast Diagnostics, Oslo University Hospital, University of Oslo, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Bjørn Helge Østerås
- Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway.
| | - Stanimir Yanakiev
- Division of Radiology and Nuclear Medicine, Department of Breast Diagnostics, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Terese Lie
- Division of Radiology and Nuclear Medicine, Department of Breast Diagnostics, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Ellen B Eben
- Division of Radiology and Nuclear Medicine, Department of Breast Diagnostics, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Randi Gullien
- Division of Radiology and Nuclear Medicine, Department of Breast Diagnostics, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Siri H B Brandal
- Division of Radiology and Nuclear Medicine, Department of Breast Diagnostics, Oslo University Hospital, University of Oslo, Oslo, Norway
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Dhurandhar V, Bhola N, Chan M, Choi S, Chung TY, Giuffre B, Hunter N, Lee K, McKessar M, Reddy R, Roberts M, Shearman C, Kay M, Bruderlin K, Winarta N, Noakes J. Feasibility study comparing synthesized mammography with digital breast tomosynthesis and digital mammography for simulated first round screening in a single BreastScreen NSW centre. J Med Imaging Radiat Oncol 2024; 68:401-411. [PMID: 38698585 DOI: 10.1111/1754-9485.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION While digital breast tomosynthesis (DBT) has proven to enhance cancer detection and reduce recall rates (RR), its integration into BreastScreen Australia for screening has been limited, in part due to perceived cost implications. This study aims to assess the cost effectiveness of digital mammography (DM) compared with synthesized mammography and DBT (SM + DBT) in a first round screening context for short-term outcomes. METHODS Clients recalled for nonspecific density (NSD) as a single lesion by both readers at the Northern Sydney Central Coast BreastScreen service in 2019 were included. Prior images were excluded to simulate first-round screening. Eleven radiologists read DM and synthesized mammography with DBT (SM + DBT) images 4 weeks apart. Recall rates (RR), reading time, and diagnostic parameters were measured, and costs for screen reading and assessment were calculated. RESULT Among 65 clients studied, 13 were diagnosed with cancer, with concordant cancer recalls. SM + DBT reduced recall rates (RR), increased reading time, maintained cancer detection sensitivity, and significantly improved other diagnostic parameters, particularly false positive rates. Benign biopsy recalls remained equivalent. While SM + DBT screen reading cost was significantly higher than DM (DM AU$890 ± 186 vs SM + DBT AU$1279 ± 265; P < 0.001), the assessment cost (DM AU$29,504 ± 9427 vs SM + DBT AU$18,021 ± 5606; P < 0.001), and combined screen reading and assessment costs were significantly lower (DM AU$30,394 ± 9508 vs SM + DBT AU$19,300 ± 5721; P = 0.001). SM + DBT screen reading and assessment of 65 patients resulted in noteworthy cost savings (AU$11,094), equivalent to assessing 12 additional clients. CONCLUSION In first round screening, DBT yields significant cost savings by effectively reducing unnecessary recalls to assessment while maintaining diagnostic efficacy.
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Affiliation(s)
- Vikrant Dhurandhar
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nalini Bhola
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Mico Chan
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Sarah Choi
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Tzu-Yun Chung
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Bruno Giuffre
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Nigel Hunter
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Katelyn Lee
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Merran McKessar
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Ranjani Reddy
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Marian Roberts
- Department of Radiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Christine Shearman
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Meredith Kay
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Ken Bruderlin
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Niko Winarta
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
| | - Jennifer Noakes
- Northern Sydney & Central Coast BreastScreen, Sydney, New South Wales, Australia
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Weigel S, Heindel W, Decker T, Weyer-Elberich V, Kerschke L, Gerß J, Hense HW. Digital Breast Tomosynthesis versus Digital Mammography for Detection of Early-Stage Cancers Stratified by Grade: A TOSYMA Subanalysis. Radiology 2023; 309:e231533. [PMID: 38051184 DOI: 10.1148/radiol.231533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Background Breast cancer screening with digital breast tomosynthesis (DBT) plus synthesized mammography (SM) increases invasive tumor detection compared with digital mammography (DM). However, it is not known how the prognostic characteristics of the cancers detected with the two screening approaches differ. Purpose To compare invasive breast cancers detected with DBT plus SM (test arm) versus DM (control arm) screening with regard to tumor stage, histologic grade, patient age, and breast density. Materials and Methods This exploratory subanalysis of the Tomosynthesis plus Synthesized Mammography (TOSYMA) study, which is a multicenter randomized controlled trial embedded in the German mammography screening program, recruited women aged 50-70 years from July 2018 to December 2020. It compared invasive cancer detection rates (iCDRs), rate differences, and odds ratios (ORs) between the arms stratified by Union for International Cancer Control (UICC) stage (I vs II-IV), histologic grade (1 vs 2 or 3), age group (50-59 vs 60-70 years), and Breast Imaging Reporting and Data System categories of breast density (A or B vs C or D). Results In total, 49 462 (median age, 57 years [IQR, 53-62 years]) and 49 669 (median age, 57 years [IQR, 53-62 years]) participants were allocated to DBT plus SM and DM screening, respectively. The iCDR of stage I tumors with DBT plus SM was 51.6 per 10 000 women (255 of 49 462) and with DM it was 30.0 per 10 000 women (149 of 49 669). DBT plus SM depicted more stage I tumors with grade 2 or 3 (166 of 49 462, 33.7 per 10 000 women) than DM (106 of 49 669, 21.3 per 10 000 women; rate difference, +12.3 per 10 000 women [95% CI: 0.3, 24.9]; OR, 1.6 [95% CI: 0.9, 2.7]). DBT plus SM achieved the highest iCDR of stage I tumors with grade 2 or 3 among women aged 60-70 years with dense breasts (41 of 7364, 55.4 per 10 000 women; rate difference, +21.6 per 10 000 women [95% CI: -21.1, 64.3]; OR, 1.6 [95% CI: 0.6, 4.5]). Conclusion DBT plus SM screening appears to lead to higher detection of early-stage invasive breast cancers of grade 2 or 3 than DM screening, with the highest rate among women aged 60-70 years with dense breasts. Clinical trial registration no. NCT03377036 © RSNA, 2023 See also the editorial by Ha and Chang in this issue.
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Affiliation(s)
- Stefanie Weigel
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Walter Heindel
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Thomas Decker
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Veronika Weyer-Elberich
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Laura Kerschke
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Joachim Gerß
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
| | - Hans-Werner Hense
- From the Clinic for Radiology and Reference Center for Mammography Münster (S.W., W.H., T.D.), Institute of Biostatistics and Clinical Research (V.W.E., L.K., J.G.), and Institute of Epidemiology and Social Medicine (H.W.H.), University of Münster and University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Münster, Germany
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11
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Holen ÅS, Bergan MB, Lee CI, Zackrisson S, Moshina N, Aase HS, Haldorsen IS, Hofvind S. Early screening outcomes before, during, and after a randomized controlled trial with digital breast tomosynthesis. Eur J Radiol 2023; 167:111069. [PMID: 37708674 DOI: 10.1016/j.ejrad.2023.111069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE To describe and compare early screening outcomes before, during and after a randomized controlled trial with digital breast tomosynthesis (DBT) including synthetic 2D mammography versus standard digital mammography (DM) (To-Be 1) and a follow-up cohort study using DBT (To-Be 2). METHODS Retrospective results of 125,020 screening examinations from four consecutive screening rounds performed in 2014-2021 were described and compared for pre-To-Be 1 (DM), To-Be 1 (DM or DBT), To-Be 2 (DBT), and post-To-Be 2 (DM) cohorts. Descriptive analyses of rates of recall, biopsy, screen-detected and interval cancer, distribution of histopathologic tumor characteristics and time spent on image interpretation and consensus were presented for the four rounds including five cohorts, one cohort in each screening round except for the To-Be 1 trail, which included a DBT and a DM cohort. Odds ratios (OR) with 95% CIs was calculated for recall and cancer detection rates. RESULTS Rate of screen-detected cancer was 0.90% for women screened with DBT in To-Be 2 and 0.64% for DM in pre-To-Be 1. The rates did not differ for the To-Be 1 DM (0.61%), To-Be 1 DBT (0.66%) and post-To-Be 2 DM (0.67%) cohorts. The interval cancer rates ranged between 0.13% and 0.20%. The distribution of histopathologic tumor characteristics did not differ between the cohorts. CONCLUSIONS Screening all women with DBT following a randomized controlled trial in an organized, population-based screening program showed a temporary increase in the rate of screen-detected cancer.
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Affiliation(s)
- Åsne Sørlien Holen
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
| | - Marie Burns Bergan
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA.
| | - Sophia Zackrisson
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Malmö, Sweden; Department of Imaging and Functional Medicine, Skåne University Hospital, Malmö, Sweden.
| | - Nataliia Moshina
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
| | | | - Ingfrid Salvesen Haldorsen
- Mohn Medical Imaging and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
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