Meta-analysis of prospective studies evaluating breast cancer detection and interval cancer rates for digital breast tomosynthesis versus mammography population screening
(2021) In European Journal of Cancer 148. p.14-23- 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.... (More)
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.
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- author
- Houssami, Nehmat ; Zackrisson, Sophia LU ; Blazek, Katrina ; Hunter, Kylie ; Bernardi, Daniela ; Lång, Kristina LU and Hofvind, Solveig
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Breast cancer, Interval cancer, Mammography, Population screening, Tomosynthesis
- in
- European Journal of Cancer
- volume
- 148
- pages
- 10 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:33706172
- scopus:85102143181
- ISSN
- 0959-8049
- DOI
- 10.1016/j.ejca.2021.01.035
- language
- English
- LU publication?
- yes
- id
- 95e9146a-f03e-4515-8ad4-b37b5edb0be8
- date added to LUP
- 2021-03-16 14:34:46
- date last changed
- 2024-09-06 16:11:19
@article{95e9146a-f03e-4515-8ad4-b37b5edb0be8, abstract = {{<p>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.</p>}}, author = {{Houssami, Nehmat and Zackrisson, Sophia and Blazek, Katrina and Hunter, Kylie and Bernardi, Daniela and Lång, Kristina and Hofvind, Solveig}}, issn = {{0959-8049}}, keywords = {{Breast cancer; Interval cancer; Mammography; Population screening; Tomosynthesis}}, language = {{eng}}, pages = {{14--23}}, publisher = {{Elsevier}}, series = {{European Journal of Cancer}}, title = {{Meta-analysis of prospective studies evaluating breast cancer detection and interval cancer rates for digital breast tomosynthesis versus mammography population screening}}, url = {{http://dx.doi.org/10.1016/j.ejca.2021.01.035}}, doi = {{10.1016/j.ejca.2021.01.035}}, volume = {{148}}, year = {{2021}}, }