Comparative Effectiveness of Digital Breast Tomosynthesis for Breast Cancer Screening among Women 40-64 Years Old
Menée à partir de données portant sur 4 480 698 femmes âgées de 40 à 64 ans et ayant bénéficié d'un examen de dépistage du cancer du sein entre 2015 et 2017 (7 602 869 mammogrammes au total), cette étude compare l'efficacité, du point de vue du taux de rappel et du taux de cancers détectés, d'une tomosynthèse mammaire numérique et d'une mammographie 2D
Background : Digital breast tomosynthesis (DBT) may have a higher cancer detection rate and lower recall compared to 2 D mammography for breast cancer screening. The goal of this study was to evaluate screening outcomes with DBT in a real-world cohort, and to characterize the population health impact of DBT as it is widely adopted.
Methods : This was an observational study evaluating breast cancer screening outcomes among women screened with 2 D mammography versus DBT. We used deidentified administrative data from a large, private health insurer and included women 40–64 screened between January 2015 to December 2017. Outcomes included recall, biopsy, and incident cancers detected. We used two complementary techniques a patient-level analysis using multivariable logistic regression and an area-level analysis evaluating the relationship between population-level adoption of DBT use and outcomes. All statistical tests were 2-sided.
Results : Our sample included 7,602,869 mammograms in 4,580,698 women, 27.5% of whom received DBT. DBT was associated with modestly lower recall compared to 2 D mammography (113.6 [99% CI = 113.0-114.2] vs 115.4 [99% CI = 115.0-115.8] per 1,000 screens, p < .001), although younger women ages 40-44 had a larger reduction in recall (153 [99% CI = 151-15] vs 164 [99% CI = 163-166] per 1000 screens, p < .001). DBT was associated with higher biopsy rates than 2 D mammography (19.6 [99% CI = 19.3-19.8] vs 15.2 [99% CI = 15.1-15.4] per 1,000 screens, p < .001) and a higher cancer detection rate (4.9 [99% CI = 4.7-5.0] vs 3.8 [99% CI = 3.7-3.9] per 1,000, p < .001). Point estimates from the area-level analysis generally supported these findings.
Conclusions : In a large population of privately insured women, DBT was associated with a slightly lower recall rate than 2 D mammography and a higher cancer detection rate. Whether this increased cancer detection improves clinical outcomes remains unknown.
Journal of the National Cancer Institute , résumé, 2020