title: Screening outcomes following implementation of digital breast tomosynthesis in a general-population screening program.
abstract: BACKGROUND
  Early data on breast cancer screening utilizing digital breast tomosynthesis (DBT) combined with digital mammography (DM) have shown improvements in false-positive and false-negative screening rates compared with DM alone. However, these trials were performed at sites where conventional mammographic screening was concurrently performed, possibly leading to selection biases or with complex, multireader algorithms not reflecting general clinical practice. Our study reports the impact on screening outcomes for DBT screening implemented in an entire clinic population.
  
  
  METHODS
  Recall rates, cancer detection, and positive predictive values of screening were compared for 15571 women screened with DBT and 10728 screened with DM alone prior to DBT implementation at a single breast imaging center. Generalized linear mixed-effects models were used to estimate the odds ratio (OR) for recall rate adjusted for age, race, presence of prior mammograms, breast density and reader. All statistical tests were two-sided.
  
  
  RESULTS
  DBT screening showed a statistically significant reduction in recalls compared to DM alone. For the entire population, there were 16 fewer recalls (8.8% vs 10.4%, P <.001, adjusted OR = 0.80, 95% confidence interval [CI] = 0.74 to 0.88, P < .001) and 0.9 additional cancers detected per 1000 screened with DBT compared to DM alone. There was a statistically significant increase in PPV1 (6.2% vs 4.4%, P = .047). In women younger than age 50 years screened with DBT, there were 17 fewer recalls (12.3% vs 14.0%, P = .02) and 3.6 additional cancer detected per 1000 screened (5.7 vs 2.2 per 1000, P = .02).
  
  
  CONCLUSIONS
  Our data support the clinical implementation of DBT in breast cancer screening; however, larger prospective trials are needed to validate our findings in specific patient subgroups.
authors.affiliation: Division of General Internal Medicine (AMM, MS), Department of Radiology (DK, MS, EFC), and Department of Biostatistics and Epidemiology (KST, DFH), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA (AMM).
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: McCarthy
authors.affiliation: Division of General Internal Medicine (AMM, MS), Department of Radiology (DK, MS, EFC), and Department of Biostatistics and Epidemiology (KST, DFH), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA (AMM).
authors.forename: Despina
authors.initials: D
authors.lastname: Kontos
authors.affiliation: Division of General Internal Medicine (AMM, MS), Department of Radiology (DK, MS, EFC), and Department of Biostatistics and Epidemiology (KST, DFH), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA (AMM).
authors.forename: Marie
authors.initials: M
authors.lastname: Synnestvedt
authors.affiliation: Division of General Internal Medicine (AMM, MS), Department of Radiology (DK, MS, EFC), and Department of Biostatistics and Epidemiology (KST, DFH), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA (AMM).
authors.forename: Kay See
authors.initials: KS
authors.lastname: Tan
authors.affiliation: Division of General Internal Medicine (AMM, MS), Department of Radiology (DK, MS, EFC), and Department of Biostatistics and Epidemiology (KST, DFH), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA (AMM).
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Heitjan
authors.affiliation: Division of General Internal Medicine (AMM, MS), Department of Radiology (DK, MS, EFC), and Department of Biostatistics and Epidemiology (KST, DFH), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA (AMM).
authors.forename: Mitchell
authors.initials: M
authors.lastname: Schnall
authors.affiliation: Division of General Internal Medicine (AMM, MS), Department of Radiology (DK, MS, EFC), and Department of Biostatistics and Epidemiology (KST, DFH), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; General Medicine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA (AMM). emily.conant@uphs.upenn.edu.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Conant
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000517:prevention & control; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D011857:Radiographic Image Interpretation, Computer-Assisted; D012042:Registries; D014057:Tomography, X-Ray Computed / Q000379:methods*