Performance Metrics of Screening Digital Breast Tomosynthesis Based on Years Since a Prior Breast Cancer Diagnosis

BACKGROUND. Mammography surveillance protocols after breast cancer treatment vary widely. Some practices recommend performing diagnostic mammography for a certain number of years or indefinitely, whereas others recommend returning immediately to screening. OBJECTIVE. This study's objective was to determine performance metrics of screening digital breast tomosynthesis (DBT) in patients who resume screening mammography immediately after breast cancer treatment, based on the number of years since the breast cancer diagnosis. METHODS. This retrospective study included screening DBT examinations performed from January 2013 to June 2019 in patients who resumed screening mammography immediately after a prior breast cancer diagnosis. Multivariable logistic regression models with generalized estimating equations were used to evaluate associations between screening performance metrics and years since the prior breast cancer diagnosis, controlling for age, race and ethnicity, breast density, presence of a prior screening mammogram, and interpreting radiologist. RESULTS. The study included 8090 patients (mean age, 65 ± 11 [SD] years) with a prior breast cancer diagnosis who underwent 30,812 screening DBT examinations during the study period. The cancer detection rate (CDR) was 8.6 per 1000 examinations (265/30,812), abnormal interpretation rate (AIR) was 5.7% (1750/30,812), PPV1 was 15.1% (265/1750), sensitivity was 80.3% (265/330), specificity was 95.1% (28,997/30,482), and false-negative rate was 2.1 per 1000 examinations (65/30,812). CDR showed a significant independent positive association with years since breast cancer diagnosis (adjusted OR, 1.03; 95% CI, 1.01-1.05; p < .001), being lowest more than 2 to up to 3 years after diagnosis (4.9 per 1000 examinations) and highest more than 8 to up to 9 years after diagnosis (11.2 per 1000 examinations). AIR showed a significant independent negative association with years since breast cancer diagnosis (adjusted OR, 0.99; 95% CI, 0.98-1.00; p = .01), being highest 1 year or less after diagnosis (7.5%) and lowest more than 5 to up to 6 years after diagnosis (5.0%). CONCLUSION. Among 8090 patients with a prior breast cancer diagnosis, even though the AIR was higher during the year after diagnosis compared with subsequent years, the AIR remained acceptably low (< 10%) in all years. CLINICAL IMPACT. These results support the study institution's mammographic surveillance protocol for patients with a prior breast cancer diagnosis of returning immediately to DBT screening.