Meta-analysis of prospective studies evaluating breast cancer detection and interval cancer rates for digital breast tomosynthesis versus mammography population screening. (May 2021)

• Record Type: Journal Article
• Authors: Houssami, Nehmat; Zackrisson, Sophia; Blazek, Katrina; Hunter, Kylie; Bernardi, Daniela; Lång, Kristina; Hofvind, Solveig
• Is Part Of: European journal of cancer. Volume 148(2021)
• Page Start: 14
• Page End: 23
• Publication Date: 2021-05
• Subjects: Breast cancer -- Interval cancer -- Population screening -- Mammography -- Tomosynthesis; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2021.01.035
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Introduction: Breast cancer (BC) screening using digital breast tomosynthesis (DBT) has been shown to increase cancer detection compared with mammography; however, it is unknown whether DBT impacts interval cancer rate (ICR). Methods: We systematically identified prospective DBT studies reporting data on screen-detected and interval BCs to perform a study-level meta-analysis of the comparative effect of DBT on ICR in population screening. Meta-analysis of cancer detection rate (CDR), ICR, and the differences between DBT and mammography in CDR and ICR pooled estimates, included random-effects. Sensitivity analysis examined whether study methods (imaging used, comparison group design, interval BC ascertainment) affected pooled estimates. Results: Five eligible prospective (non-randomised) studies of DBT population screening reported on 129, 969 DBT-screened participants and 227, 882 mammography-only screens, including follow-up publications reporting interval BC data. Pooled CDR was 9.03/1000 (95% confidence interval [CI] 8.53–9.56) for DBT, and 5.95/1000 (95% CI 5.65–6.28) for mammography: the pooled difference in CDR was 3.15/1000 (95% CI 2.53–3.77), and was evident for the detection of invasive and in-situ malignancy. Pooled ICR was 1.56/1000 DBT screens (95% CI 1.22–2.00), and 1.75/1000 mammography screens (95% CI 1.46–2.11): the estimated pooled difference in ICR was −0.15/1000 (95% CI –0.59 to 0.29) and was not substantially altered in several sensitivity analyses. Conclusions: Meta-analysis shows consistent evidence that DBT significantly increased CDR compared with mammography screening; however, there was little difference between DBT and mammography in pooled ICR. This could suggest, but does not demonstrate, some over-detection. Meta-analysis using individual participant data, randomised trials and comparative studies quantifying cumulative detection and ICR over repeat DBT screen-rounds would provide valuable evidence to inform screening programs. Highlights: Meta-analysis of digital breast tomosynthesis (DBT) studies reporting screen-detected and interval cancer data. Pooled cancer detection rate (CDR) was 9.03/1000 for DBT population screening. Digital mammography (DM) CDR was 5.95/1000: pooled CDR difference was 3.15/1000. Pooled interval cancer rate (ICR) was 1.56/1000 for DBT and 1.75/1000 for DM. Pooled difference in ICR between DBT and DM was −0.15/1000 (95% CI –0.59 to 0.29).