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An individual participant data meta-analysis of breast cancer detection and recall rates for digital breast tomosynthesis versus digital mammography population screening

Libesman, Sol ; Zackrisson, Sophia LU ; Hofvind, Solveig ; Seidler, Anna Lene ; Bernardi, Daniela ; Lång, Kristina LU ; Robledo, Kristy P. and Houssami, Nehmat (2022) In Clinical Breast Cancer 22(5). p.647-654
Abstract

Background: Although digital breast tomosynthesis (DBT) improves breast cancer screen-detection compared to digital mammography (DM), there is less evidence on comparative screening outcomes by age and breast density, and inconsistent evidence on its effect on recall rate. Method: We performed an individual participant data (IPD) meta-analysis from DBT screening studies (identified to November, 30 2019) that contributed to the study protocol. We estimated and compared cancer detection rate (CDR), recall rate, and positive predictive value (PPV) for recall for DBT and DM screening. Two-stage random-effects meta-analyses of detection outcomes adjusted for study and age, and were estimated in age and density subgroups. Screen-detected... (More)

Background: Although digital breast tomosynthesis (DBT) improves breast cancer screen-detection compared to digital mammography (DM), there is less evidence on comparative screening outcomes by age and breast density, and inconsistent evidence on its effect on recall rate. Method: We performed an individual participant data (IPD) meta-analysis from DBT screening studies (identified to November, 30 2019) that contributed to the study protocol. We estimated and compared cancer detection rate (CDR), recall rate, and positive predictive value (PPV) for recall for DBT and DM screening. Two-stage random-effects meta-analyses of detection outcomes adjusted for study and age, and were estimated in age and density subgroups. Screen-detected cancer characteristics were summarized descriptively within studies and screening-groups. Results: Four prospective studies, from European population-based programs, contributed IPD for 66,451 DBT-screened participants and 170,764 DM-screened participants. Age-adjusted pooled CDR difference between DBT and DM was 25.49 of 10,000 (95% CI:6.73-44.25). There was suggestive evidence of a higher CDR for DBT compared to DM in the high-density (35.19 of 10,000; 95% CI:17.82-56.56) compared to low-density (17.4 of 10,000; 95% CI:7.62-27.18) group (P =.08). Pooled CDR difference between DBT and DM did not differ across age-groups (P =.71). Age-adjusted recall rate difference was 0.18% (95% CI:-0.80–1.17), indicating no difference between DBT and DM- this finding did not differ across age-groups (P =.96). Recall PPV was higher for DBT than DM with an estimated rate ratio of 1.31 (95% CI:1.07-1.61). Discussion: DBT improved CDR compared to DM in all age and density groups. DBT also had higher recall PPV than DM, although further research is needed to explore the heterogeneity in recall rates across studies.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breast cancer, Cancer screening, Digital breast tomosynthesis, Mammography, Meta-analysis
in
Clinical Breast Cancer
volume
22
issue
5
pages
647 - 654
publisher
Elsevier
external identifiers
  • scopus:85126764930
  • pmid:35246389
ISSN
1526-8209
DOI
10.1016/j.clbc.2022.02.005
language
English
LU publication?
yes
additional info
Funding Information: This work was funded by the National Breast Cancer Foundation (NBCF Australia) Chair in Breast Cancer Prevention (grant EC-21-001), and a National Health and Medical Research Council Investigator (Leader) grant (1194410), awarded to Dr. Houssami. Dr. Zackrisson reports grants from the Swedish Cancer Society, grants from Governmental funding (Region Skane), during the conduct of the study; in addition, Dr. Zackrisson has a patent approved, US (application no PCT/EP2014/057,372) issued. Publisher Copyright: © 2022 Elsevier Inc.
id
9e13f15c-34d2-4e88-87dc-e94fe3282867
date added to LUP
2022-04-20 15:03:17
date last changed
2024-04-22 03:52:14
@article{9e13f15c-34d2-4e88-87dc-e94fe3282867,
  abstract     = {{<p>Background: Although digital breast tomosynthesis (DBT) improves breast cancer screen-detection compared to digital mammography (DM), there is less evidence on comparative screening outcomes by age and breast density, and inconsistent evidence on its effect on recall rate. Method: We performed an individual participant data (IPD) meta-analysis from DBT screening studies (identified to November, 30 2019) that contributed to the study protocol. We estimated and compared cancer detection rate (CDR), recall rate, and positive predictive value (PPV) for recall for DBT and DM screening. Two-stage random-effects meta-analyses of detection outcomes adjusted for study and age, and were estimated in age and density subgroups. Screen-detected cancer characteristics were summarized descriptively within studies and screening-groups. Results: Four prospective studies, from European population-based programs, contributed IPD for 66,451 DBT-screened participants and 170,764 DM-screened participants. Age-adjusted pooled CDR difference between DBT and DM was 25.49 of 10,000 (95% CI:6.73-44.25). There was suggestive evidence of a higher CDR for DBT compared to DM in the high-density (35.19 of 10,000; 95% CI:17.82-56.56) compared to low-density (17.4 of 10,000; 95% CI:7.62-27.18) group (P =.08). Pooled CDR difference between DBT and DM did not differ across age-groups (P =.71). Age-adjusted recall rate difference was 0.18% (95% CI:-0.80–1.17), indicating no difference between DBT and DM- this finding did not differ across age-groups (P =.96). Recall PPV was higher for DBT than DM with an estimated rate ratio of 1.31 (95% CI:1.07-1.61). Discussion: DBT improved CDR compared to DM in all age and density groups. DBT also had higher recall PPV than DM, although further research is needed to explore the heterogeneity in recall rates across studies.</p>}},
  author       = {{Libesman, Sol and Zackrisson, Sophia and Hofvind, Solveig and Seidler, Anna Lene and Bernardi, Daniela and Lång, Kristina and Robledo, Kristy P. and Houssami, Nehmat}},
  issn         = {{1526-8209}},
  keywords     = {{Breast cancer; Cancer screening; Digital breast tomosynthesis; Mammography; Meta-analysis}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{647--654}},
  publisher    = {{Elsevier}},
  series       = {{Clinical Breast Cancer}},
  title        = {{An individual participant data meta-analysis of breast cancer detection and recall rates for digital breast tomosynthesis versus digital mammography population screening}},
  url          = {{http://dx.doi.org/10.1016/j.clbc.2022.02.005}},
  doi          = {{10.1016/j.clbc.2022.02.005}},
  volume       = {{22}},
  year         = {{2022}},
}