title: Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium.
abstract: 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.
authors.affiliation: Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. emily.conant@uphs.upenn.edu.
authors.forename: Emily F
authors.identifier: http://orcid.org/0000-0001-9331-644X
authors.initials: EF
authors.lastname: Conant
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Elisabeth F
authors.initials: EF
authors.lastname: Beaber
authors.affiliation: Department of Surgery, University of Vermont, Burlington, VT, USA.|University of Vermont Cancer Center, Burlington, VT, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Sprague
authors.affiliation: University of Vermont Cancer Center, Burlington, VT, USA.|Department of Radiology, University of Vermont, Burlington, VT, USA.
authors.forename: Sally D
authors.initials: SD
authors.lastname: Herschorn
authors.affiliation: University of Vermont Cancer Center, Burlington, VT, USA.|Department of Pathology, University of Vermont, Burlington, VT, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Weaver
authors.affiliation: Department of Community and Family Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Onega
authors.affiliation: Department of Community and Family Medicine and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.|Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: McCarthy
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University of St. Louis, St. Louis, MO, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Poplack
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
authors.affiliation: Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Schnall
authors.affiliation: Cancer Research and Biostatistics, Seattle, WA, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015331:Cohort Studies; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Breast cancer screening; Digital breast tomosynthesis; Mammography