Interval breast cancer rates for digital breast tomosynthesis versus digital mammography population screening : An individual participant data meta-analysis
Houssami, Nehmat ; Hofvind, Solveig ; Soerensen, Anne L. ; Robledo, Kristy P. ; Hunter, Kylie ; Bernardi, Daniela ; Lång, Kristina LU ; Johnson, Kristin LU
; Aglen, Camilla F.
and Zackrisson, Sophia
LU
(2021)
In EClinicalMedicine
34.
- Abstract
Background: Digital breast tomosynthesis (DBT) improves breast cancer (BC) detection compared to mammography, however, it is unknown whether this reduces interval cancer rate (ICR) at follow-up. Methods: Using individual participant data (IPD) from DBT screening studies (identified via periodic literature searches July 2016 to November 2019) we performed an IPD meta-analysis. We estimated ICR for DBT-screened participants and the difference in pooled ICR for DBT and mammography-only screening, and compared interval BC characteristics. Two-stage meta-analysis (study-specific estimation, pooled synthesis) of ICR included random-effects, adjusting for study and age, and was estimated in age and density subgroups. Comparative screening... (More)
Background: Digital breast tomosynthesis (DBT) improves breast cancer (BC) detection compared to mammography, however, it is unknown whether this reduces interval cancer rate (ICR) at follow-up. Methods: Using individual participant data (IPD) from DBT screening studies (identified via periodic literature searches July 2016 to November 2019) we performed an IPD meta-analysis. We estimated ICR for DBT-screened participants and the difference in pooled ICR for DBT and mammography-only screening, and compared interval BC characteristics. Two-stage meta-analysis (study-specific estimation, pooled synthesis) of ICR included random-effects, adjusting for study and age, and was estimated in age and density subgroups. Comparative screening sensitivity was calculated using screen-detected and interval BC data. Findings: Four prospective DBT studies, from European population-based programs, contributed IPD for 66,451 DBT-screened participants: age-adjusted pooled ICR was 13.17/10,000 (95%CI: 8.25–21.02). Pooled ICR was higher in the high-density (21.08/10,000; 95%CI: 6.71–66.27) than the low-density (8.63/10,000; 95%CI: 5.25–14.192) groups (P = 0.03) however estimates did not differ across age-groups (P = 0.32). Based on two studies that also provided data for 153,800 mammography screens (age-adjusted ICR 17.69/10,000; 95%CI: 13.22–23.66), DBT's pooled ICR was 16.83/10,000 (95%CI: 11.89–23.82). Comparative meta-analysis showed a non-significant difference in ICR (-0.44/10,000; 95%CI: -11.00–10.11) and non-significant difference in screening sensitivity (6.79%; 95%CI: -0.73–14.87%) between DBT and DM but a significant pooled difference in cancer detection rate of 33.49/10,000 (95%CI: 23.88–43.10). Distribution of interval BC prognostic characteristics did not differ between screening modalities except that those occurring in DBT-screened participants were significantly more likely to be negative for axillary-node metastases (P = 0.005). Interpretation: Although heterogeneity in ICR estimates and few datasets limit recommendations, there was no difference between DBT and mammography in pooled ICR despite DBT increasing cancer detection.
(Less)
- author
- Houssami, Nehmat
; Hofvind, Solveig
; Soerensen, Anne L.
; Robledo, Kristy P.
; Hunter, Kylie
; Bernardi, Daniela
; Lång, Kristina
LU
; Johnson, Kristin
LU
; Aglen, Camilla F.
and Zackrisson, Sophia
LU
- organization
- publishing date
- 2021-04
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Breast cancer, Cancer screening, Digital breast tomosynthesis, Interval cancer, Mammography, Meta-analysis
- in
- EClinicalMedicine
- volume
- 34
- article number
- 100804
- publisher
- Lancet Publishing Group
- external identifiers
-
- pmid:33997729
- scopus:85117430671
- ISSN
- 2589-5370
- DOI
- 10.1016/j.eclinm.2021.100804
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2021 The Author(s)
- id
- ed220024-6682-4895-8459-22a77776a5c3
- date added to LUP
- 2021-11-10 09:16:25
- date last changed
- 2024-07-13 22:20:36
@article{ed220024-6682-4895-8459-22a77776a5c3,
abstract = {{<p>Background: Digital breast tomosynthesis (DBT) improves breast cancer (BC) detection compared to mammography, however, it is unknown whether this reduces interval cancer rate (ICR) at follow-up. Methods: Using individual participant data (IPD) from DBT screening studies (identified via periodic literature searches July 2016 to November 2019) we performed an IPD meta-analysis. We estimated ICR for DBT-screened participants and the difference in pooled ICR for DBT and mammography-only screening, and compared interval BC characteristics. Two-stage meta-analysis (study-specific estimation, pooled synthesis) of ICR included random-effects, adjusting for study and age, and was estimated in age and density subgroups. Comparative screening sensitivity was calculated using screen-detected and interval BC data. Findings: Four prospective DBT studies, from European population-based programs, contributed IPD for 66,451 DBT-screened participants: age-adjusted pooled ICR was 13.17/10,000 (95%CI: 8.25–21.02). Pooled ICR was higher in the high-density (21.08/10,000; 95%CI: 6.71–66.27) than the low-density (8.63/10,000; 95%CI: 5.25–14.192) groups (P = 0.03) however estimates did not differ across age-groups (P = 0.32). Based on two studies that also provided data for 153,800 mammography screens (age-adjusted ICR 17.69/10,000; 95%CI: 13.22–23.66), DBT's pooled ICR was 16.83/10,000 (95%CI: 11.89–23.82). Comparative meta-analysis showed a non-significant difference in ICR (-0.44/10,000; 95%CI: -11.00–10.11) and non-significant difference in screening sensitivity (6.79%; 95%CI: -0.73–14.87%) between DBT and DM but a significant pooled difference in cancer detection rate of 33.49/10,000 (95%CI: 23.88–43.10). Distribution of interval BC prognostic characteristics did not differ between screening modalities except that those occurring in DBT-screened participants were significantly more likely to be negative for axillary-node metastases (P = 0.005). Interpretation: Although heterogeneity in ICR estimates and few datasets limit recommendations, there was no difference between DBT and mammography in pooled ICR despite DBT increasing cancer detection.</p>}},
author = {{Houssami, Nehmat and Hofvind, Solveig and Soerensen, Anne L. and Robledo, Kristy P. and Hunter, Kylie and Bernardi, Daniela and Lång, Kristina and Johnson, Kristin and Aglen, Camilla F. and Zackrisson, Sophia}},
issn = {{2589-5370}},
keywords = {{Breast cancer; Cancer screening; Digital breast tomosynthesis; Interval cancer; Mammography; Meta-analysis}},
language = {{eng}},
publisher = {{Lancet Publishing Group}},
series = {{EClinicalMedicine}},
title = {{Interval breast cancer rates for digital breast tomosynthesis versus digital mammography population screening : An individual participant data meta-analysis}},
url = {{http://dx.doi.org/10.1016/j.eclinm.2021.100804}},
doi = {{10.1016/j.eclinm.2021.100804}},
volume = {{34}},
year = {{2021}},
}