Digital breast tomosynthesis may reduce recall rates

JAMA Oncology published McDonald et al research regarding the efficacy of digital breast tomosynthesis (DBT) on recall rates versus that of digital mammography (DM), and also its sustainability over the long term.

The study was a retrospective analysis of a total of 44468 screening events performed on 23958 women whose average age was 56 years and were followed over a period of 4 years.

Recall rates rose slightly for years 1 to 3 of DBT (88, 90, and 92 per 1000 screened, respectively) but remained significantly reduced compared with the DM zero rate of 104 per 1000 screened. The cancer cases per recalled patients continued to rise from DM zero rate of 4.4% to 6.2% for years 1 to 3 of DBT, respectively. Outcomes assessed for the most recent screening for individual women undergoing only 1, 2, or 3 DBT screenings during the study period demonstrated decreasing recall rates of 130, 78, and 59 per 1000 screened, respectively (P < .001). Interval cancer rates, determined using available follow-up data, decreased from 0.7 per 100 women screened with the use of DM to 0.5 per 1000 screened with the use of DBT.

Digital breast tomosynthesis screening outcomes are sustainable, with significant recall reduction, increasing cancer cases per recalled patients, and a decline in interval cancers.

USPSTF breast cancer screening guidelines

The United States Preventative Services Task Force (USPSTF) issued new guidelines for when and how often women should be screened for breast cancer.

The USPSTF recommends biennial screening mammography for women 50-74 years.  Women of average risk between the ages of 40 and 49 should make an individual choice about whether to initiate screening every other year.  The UUPSTF recommends against teaching self-breast examination.

       

The USPSTF’s recommendations are similar to those issued recently by the American Cancer Society.  ACR recommends initiation of annual screening at age 45 and transition to biennial at age 55 as long as a woman has life expectancy of 10 years or longer.