Digital breast tomosynthesis (DBT) with supplemental MRI
New BCSC study reveals using digital breast tomosynthesis (DBT) and supplemental MRI yields more benefits but also confers more risks, according to simulation data.
A BCSC-CISNET collaborative study published on August 26 in JAMA Internal Medicine here found that using digital breast tomosynthesis (DBT) with supplemental MRI offers more benefits but also carries more harms that using DBT alone. Led by Natasha Stout, PhD, from Harvard Medical School and Harvard Pilgrim Health Care Institute, researchers found that while DBT and MRI together prevent more deaths from breast cancer, especially in women with extremely dense breasts, they also result in more false-positive recalls and biopsy recommendations.
The study projected long-term outcomes for different breast cancer screening strategies using DBT, mammography, and supplemental MRI, analyzing starting ages of 40, 45, or 50, and screening up to age 74. Results showed that focusing MRI use on the 10% of screen-aged women with extremely dense breasts achieves similar risk-benefit trade-offs as mammography alone.
Key findings include:
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Biennial DBT screening starting at age 50 prevented 7.4 deaths, with 884 false positives and 151 false-positive biopsies. Starting at 40 prevented 8.5 deaths but increased false positives to 1,392 and false-positive biopsies to 221.
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Adding MRI for women 50–74 with extremely dense breasts increased deaths averted to 7.6, with 919 false positives and 180 false-positive biopsies.
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Extending MRI to women with heterogeneously dense breasts raised deaths averted to 8.0, with 1,088 false positives and 343 false-positive biopsies.
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Screening all women aged 40–74 with MRI prevented 9.5 deaths but caused 1,850 false positives and 628 false-positive biopsies.
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Annual screening led to a modest increase in deaths averted but almost doubled the number of false-positive results.
The study offers valuable insights on potential screening strategies for women with dense breasts following the recent federal mandate on breast density reporting.
Stout NK, Miglioretti DL, Su YR, Lee CI, Abraham L, Alagoz O, de Koning HJ, Hampton JM, Henderson L, Lowry KP, Mandelblatt JS, Onega T, Schechter CB, Sprague BL, Stein S, Trentham-Dietz A, van Ravesteyn NT, Wernli KJ, Kerlikowske K, Tosteson ANA. Breast Cancer Screening Using Mammography, Digital Breast Tomosynthesis, and Magnetic Resonance Imaging by Breast Density. JAMA Intern Med. 2024 Oct 1;184(10):1222-1231. doi: 10.1001/jamainternmed.2024.4224. PMID: 39186304; PMCID: PMC11348087. [Link]
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