Benefits of DBT Depend on Many Woman-Level Factors

New BCSC study suggests that the benefits of digital breast tomosynthesis (DBT) depend on a woman's age, breast density, and screening round.

Posted by Kathryn Lowry, MD at 9:02 AM on Jul 28, 2020

A new study from the Breast Cancer Surveillance Consortium published in JAMA Network Open suggests that improvements in recall rate and cancer detection with digital breast tomosynthesis (DBT) compared to digital mammography (DM) depend on a woman’s age, screening round, and breast density. In the study co-led by Dr. Kathryn Lowry (University of Washington) and Dr. Yates Coley (Kaiser Permanente Washington), the largest improvements in recall and cancer detection with DBT were seen with baseline screening examinations. For example, in women ages 50-59, recall rates decreased by approximately 37 per 1,000 women, and cancer detection increased by 2.9 per 1,000 women. These improvements translate into fewer women with false positive exams that require additional work-up, which can cause anxiety, stress, and financial burden even when no cancer is found. After the baseline screening examination, women who have breast density categories “heterogeneously dense” and women over the age of 50 with “scattered fibroglandular density” had improvements in both recall and cancer detection. However, women in the “extremely dense” category did not have better cancer detection or recall rates with DBT compared to DM. This finding is significant because women with “extremely dense breasts” (who make up approximately 10% of women receiving screening mammograms) have the highest risk of cancers missed by screening mammography. These results suggest that for women in this category, screening outcomes are unlikely to change even as facilities fully transition from DM to DBT for screening.

Full Text Citation and Link: Lowry, KP; Coley, RY; Miglioretti, DL; Kerlikowske, K; Henderson, LM; Onega, T; Sprague, BL; Lee, JM; Herschorn, S; Tosteson, ANA; Rauscher, G; Lee, CI. Screening Performance of Digital Breast Tomosynthesis vs Digital Mammography in Community Practice by Patient Age, Screening Round, and Breast Density. JAMA Netw Open. 2020;3(7):e2011792. doi:10.1001/jamanetworkopen.2020.11792 [Link to Article]

These findings featured here:

Posted by: Kathryn Lowry, MD