DBT associated with higher detection rates, lower recall rates among all age groups

Breast cancer screening with digital breast tomosynthesis (DBT) improves breast cancer detection and leads to fewer false-positive recalls, according to new research published in JAMA Oncology.

“The controversy about routine mammographic screening examinations centers around the risk-benefit balance of the procedure,” wrote Emily F. Conant, MD, Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues. “A screening examination that minimizes false-positive results while maintaining or even increasing the detection of clinically significant breast cancers compared with conventional 2-dimensional mammography may have a favorable risk-benefit ratio.”

The authors studied data from more than 180,000 breast cancer screening examinations for more than 96,000 women who received care at one of three research centers in in the northeastern United States. All patients underwent screening from Jan. 1, 2011, through Sept. 30, 2014. While 71.7 percent of the examinations used digital mammography (DM), the remaining examinations used DBT.

Overall, examinations performed with DBT were associated with lower recall rates and higher cancer detection among all age groups and all breast density categories. Could these findings have potential policy implications?

“This shift in the risk-benefit balance of outcomes with DBT for women aged 40 to 49 years with outcomes considered to be acceptable for DM for women aged 50 to 59 years by systematic reviews (eg, US Preventive Services Task Force) is compelling evidence to support reconsideration of routine mammographic screening with DBT for these younger women,” the authors wrote.

Screening with DBT was also associated with a higher proportion of invasive breast cancers that were 1 centimeter or smaller and node negative, especially in women between the ages of 40 and 49 years old. These smaller cancers, the authors added, “are expected to be associated with a better long-term prognosis.”

Conant and colleagues also noted that their study had certain limitations, including the fact that most women had health insurance and minorities were underrepresented. Also, the research center radiologists all implemented DBT at different times, so their experience levels may not all be equal.