Tomosynthesis may be better than digital mammography in patients with family history of breast cancer
Screening with digital breast tomosynthesis may provide more accurate screening than digital mammography for women with a family history of breast cancer, especially if they have dense breasts, a study found.
Digital breast tomosynthesis reduced recall rates and increased specificity compared to digital mammography screening in women with a relative with breast cancer, a study found.
To compare the performance of the two screening modes in women with a family history of breast cancer, researchers conducted a comparative cohort study at imaging facilities affiliated with the Breast Cancer Surveillance Consortium from 2011 to 2018. The main outcomes were the risk differences in rates of recall, cancer detection, interval cancer, advanced cancer, and biopsy, as well as positive predictive values, sensitivity, and specificity of the tests. Results were published May 22 by JAMA Oncology.
In the sample, 208,945 women with a family history of breast cancer underwent 502,357 screening examinations. Tomosynthesis performed significantly better on the outcomes of recall rate (absolute risk difference [ARD], −1.51%; 95% CI, −2.42% to −0.59%) and specificity (ARD, 1.56%; 95% CI, 0.65% to 2.46%) in the overall cohort and among women with a first-degree relative (ARD in recall rate, −1.72% [95% CI, −2.70% to −0.74%]; ARD in specificity, 1.75%; [95% CI, 0.81% to 2.69%]).
Among women with only second-degree relatives with cancer, the biopsy rate was significantly higher with tomosynthesis (ARD, 0.39%; 95% CI, 0.18% to 0.61%). Significant differences were also observed for the rate of ductal carcinoma in situ detection in women with almost entirely fatty breasts (ARD, −0.71 per 1,000 examinations; 95% CI, −1.03 to −0.38 per 1,000 examinations) and recall rate (ARD, −1.90%; 95% CI, −2.88% to −0.92%) and specificity (ARD, 1.93%; 95% CI, 0.97% to 2.89%) in women with scattered fibroglandular densities.
Significant differences were also observed in the positive predictive value for recall (ARD, 1.75%; 95% CI, 0.84% to 2.67%) in women with heterogeneously dense breasts, as well as the biopsy rate (ARD, 0.48%; 95% CI, 0.16% to 0.80%) and advanced cancer rate (ARD, −0.61 per 1,000 examinations; 95% CI, −1.02 to −0.20 per 1,000 examinations) in women with extremely dense breasts. Tomosynthesis screening led to a higher proportion of screening-detected early-stage, invasive cancers with favorable prognostic characteristics.
“Our study provides new evidence to guide the use of DBT [digital breast tomosynthesis] in screening women with a family history of breast cancer, suggesting that DBT may be used more generally in this population or selectively based on breast cancer family history category and for extremely dense breasts,” the authors concluded.