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Interval and Subsequent Round Breast Cancer in a Randomized Controlled Trial Comparing Digital Breast Tomosynthesis
Solveig Hofvind1, Nataliia Moshina1, Åsne S Holen1
1From the Cancer Registry of Norway, PO 5313, Maiorstuen, 0304 Oslo, Norway (S.H., N.M., Å.S.H., A.S.D.); Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Services, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia (N.H.); Department of Radiology (H.S.A., I.S.H.), Department of Pathology (L.A.A.), and Mohn Medical Imaging and Visualization Centre (I.S.H.), Haukeland University Hospital, Bergen, Norway; and Department of Clinical Medicine (H.S.A., I.S.H.), Section for Pathology (L.A.A.), and Centre for Cancer Biomarkers CCBIO (L.A.A.), University of Bergen, Bergen, Norway.
Abstract:
Background Prevalent digital breast tomosynthesis (DBT) has shown higher cancer detection rates and lower recall rates compared with those of digital mammography (DM). However, data are limited on rates and histopathologic tumor characteristics of interval and subsequent round screen-detected cancers for DBT. Purpose To follow women randomized to screening with DBT or DM and to investigate rates and tumor characteristics of interval and subsequent round screen-detected cancers. Materials and Methods To-Be is a randomized controlled trial comparing the outcome of DBT and DM in organized breast cancer screening. The trial included 28 749 women, with 22 306 women returning for subsequent DBT screening 2 years later (11 201 and 11 105 originally screened with DBT and DM, respectively). Differences in rates, means, and distribution of histopathologic tumor characteristics between women prevalently screened with DBT versus DM were evaluated with Z tests, t tests, and χ2 tests. Relative risk (RR) with 95% CIs was calculated for the cancer rates. Results Interval cancer rates were 1.4 per 1000 screens (20 of 14 380; 95% CI: 0.9, 2.1) for DBT versus 2.0 per 1000 screens (29 of 14 369; 95% CI: 1.4, 2.9; P = .20) for DM. The rates of subsequent round screen-detected cancer were 8.1 per 1000 (95% CI: 6.6, 10.0) for women originally screened with DBT and 9.1 per 1000 (95% CI: 7.4, 11.0; P = .43) for women screened with DM. The distribution of tumor characteristics did not differ between groups for either interval or subsequent screen-detected cancer. The RR of interval cancer was 0.69 (95% CI: 0.39, 1.22; P = .20) for DBT versus DM, whereas RR of subsequent screen-detected cancer for women prevalently screened with DBT versus DM was 0.89 (95% CI: 0.67, 1.19; P = .43). Conclusion Rates of interval or subsequent round screen-detected cancers and their tumor characteristics did not differ between women originally screened with digital breast tomosynthesis (DBT) versus digital mammography. The analysis suggests that the benefits of prevalent DBT screening did not come at the expense of worse downstream screening performance measures in a population-based screening program. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Taourel in this issue.
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