Is One Screening Strategy Higher?
Total, screening with digital breast tomosynthesis (DBT) didn’t seem to detect extra interval or superior breast cancers in contrast with digital mammography, a comparative examine suggests.
Extra particularly, for the 96.4% of ladies with nondense breasts, heterogeneously dense breasts, or extraordinarily dense breasts who weren’t at excessive threat of breast most cancers, the 2 screening modalities carried out equally.
However for a small proportion of ladies at excessive threat who had extraordinarily dense breasts, the charges of superior most cancers had been considerably decrease with DBT than with digital mammography.
Total, the findings point out that the majority girls “may bear both screening take a look at and have the identical potential advantage of averting a loss of life from breast most cancers,” Karla Kerlikowske, MD, San Francisco Veterans Affairs Medical Heart, California, instructed Medscape Medical Information by way of e-mail. The exception, she famous, is the three.6% of ladies with extraordinarily dense breasts and higher-than-average breast most cancers threat.
The examine was revealed on-line June 14 in JAMA.
The aim of DBT has been to enhance most cancers detection and avert deaths amongst girls with dense breasts by lowering the charges of missed, or interval, cancers. However the proof to this point has not persistently discovered that DBT outperforms digital mammography.
Within the present examine, Kerlikowske and colleagues evaluated whether or not one screening modality was related to a decrease threat of interval invasive and superior breast most cancers amongst girls with dense breasts.
The researchers obtained knowledge from 5 Breast Most cancers Surveillance Consortium mammography registries, which included 504,427 girls. The median age on the time of mammography was 58 years. Between January 2011 and December 2018, 308,141 girls underwent solely digital mammography, 56,939 underwent solely DBT mammography, and 139,347 underwent each digital and DBT mammography.
Total charges for detecting interval invasive most cancers had been 0.57 per 1000 examinations for DBT and 0.61 per 1000 examinations for digital mammography. The distinction of 0.4 per 1000 exams was not vital (P = .43).
Though DBT detected considerably fewer superior cancers general ― 0.36 per 1000 examinations in contrast with 0.45 per 1000 for digital mammography ― when stratified by breast density and most cancers threat, superior most cancers charges appeared considerably decrease just for girls with extraordinarily dense breasts who had been at excessive threat (0.27 vs 0.80), not for these at low to common threat (0.54 vs 0.42).
Display screen-detected stage I most cancers charges had been considerably greater with DBT in contrast with digital mammography for ladies with scattered fibroglandular densities and for ladies with a excessive breast most cancers threat (a 5-year threat of ≥1.67%).
The authors additionally discovered that the false constructive recall price for DBT was a lot decrease than for digital mammography — 66.2 per 1000 examinations vs 83.4 per 1000 — as was the false constructive short-interval follow-up advice — 11.2 per 1000 examinations for DBT vs 17.9 per 1000 for digital mammography.
A draw back to DBT, Kerlikowske famous, is that “insurance coverage corporations do not all reimburse for DBT, so girls might not assume it definitely worth the out-of-pocket price to pay for DBT when there isn’t any added advantage of averting a loss of life from breast most cancers in comparison with digital mammography.”
In an accompanying editorial, two specialists present a barely totally different interpretation for the findings.
Had the interval most cancers price had been decrease amongst sufferers who underwent screening with DBT than amongst those that underwent digital mammography, this might have prompt that DBT detects extra aggressive cancers earlier, which theoretically would lead to a lower in breast most cancers mortality, argue Sarah Friedewald, MD, Northwestern College Feinberg College of Medication, Chicago, Illinois, and Lars Grimm, MD, Duke College College of Medication, Durham, North Carolina.
On condition that DBT didn’t cut back the speed of interval cancers in contrast with digital mammography, the editorialists counsel that the interval most cancers price may nonetheless be lowered with enhancements in screening know-how or adjustments to the screening interval. By utilizing a number of screening modalities — as an example, combining DBT and MRI — extra cancers could possibly be recognized than with DBT alone, and that might probably cut back interval most cancers charges.
In a examine involving 148,575 girls who had been screened with digital mammography, the interval most cancers price was 0.89/1000 for ladies who had been screened yearly, vs 1.45/1000 for ladies who had been screened biennially.
One drawback with an evaluation based mostly on registry knowledge is that the demographic illustration is restricted, however Black girls usually tend to expertise delays in prognosis, current with superior illness, and die from breast most cancers, the editorialists write.
Given the truth that DBT is on the market at greater than 80% of mammography amenities within the US and given its skill to detect superior breast most cancers, DBT “could also be an necessary issue to assist obtain well being fairness for breast most cancers screening,” Friedewald and Grimm write.
The examine was funded by the Affected person-Centered Outcomes Analysis Institute and the Nationwide Most cancers Institute. Kerlikowske has obtained grants from the Nationwide Most cancers Institute. Friedewald has consulted for Hologic and has obtained grants from Google. Grimm has consulted for Hologic and serves on a Medscape advisory board.
JAMA. Printed on-line June 14, 2022. Summary, Editorial
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