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Sophia Zackrisson, MD, PhD. Photo.

Sophia Zackrisson

Manager

Sophia Zackrisson, MD, PhD. Photo.

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

Author

  • Nehmat Houssami
  • Sophia Zackrisson
  • Katrina Blazek
  • Kylie Hunter
  • Daniela Bernardi
  • Kristina Lång
  • Solveig Hofvind

Summary, in English

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.

Department/s

  • LUCC: Lund University Cancer Centre
  • EpiHealth: Epidemiology for Health
  • Radiology Diagnostics, Malmö

Publishing year

2021

Language

English

Pages

14-23

Publication/Series

European Journal of Cancer

Volume

148

Document type

Journal article review

Publisher

Elsevier

Topic

  • Cancer and Oncology
  • Public Health, Global Health, Social Medicine and Epidemiology

Keywords

  • Breast cancer
  • Interval cancer
  • Mammography
  • Population screening
  • Tomosynthesis

Status

Published

Research group

  • Radiology Diagnostics, Malmö

ISBN/ISSN/Other

  • ISSN: 0959-8049