Effectiveness of Community-Based Breast Cancer Screening Using Full-Field Digital Mammography With Digital Breast...

Background Breast cancer is the most common malignancy among women worldwide and remains a leading cause of cancer-related mortality. In India, delayed presentation and limited access to organised screening programmes contribute to poorer outcomes. Community-based screening models, combined with advanced imaging techniques, may improve early detection. This study evaluates the effectiveness of screening mammography incorporating digital breast tomosynthesis (DBT) with synthesised two-dimensional imaging in a real-world urban population in Central India. Methods This community-based cross-sectional screening study involved retrospective analysis of prospectively collected data from 1275 women recruited through outreach programmes in Nagpur, India, between March 2019 and February 2020. All participants underwent full-field digital mammography (FFDM) with DBT. Imaging included two-dimensional craniocaudal views and three-dimensional mediolateral oblique tomosynthesis views, with reconstructed synthesised two-dimensional images for each breast. Breast density, BI-RADS (Breast Imaging Reporting and Data System) categories, and screening outcomes were recorded. Adjunct ultrasonography was performed in selected cases. Screening performance indicators, including cancer detection rate, recall rate, and positive predictive value for biopsy (PPV3), were calculated. Results A total of 1275 women were screened, with a mean age of 51 ± 8.09 years, and 95.8% were asymptomatic. Breast density was predominantly ACR Category B (57.4%), followed by Category C (30.2%). The majority of cases were categorised as BI-RADS 1 (75.5%) and BI-RADS 2 (15.6%), while 16 cases (1.3%) were classified as BI-RADS 4 lesions. A statistically significant association was observed between breast density and BI-RADS categories (p = 0.018), with higher BI-RADS categories more frequent in women with heterogeneously dense breasts. No significant association was found between age group and BI-RADS categories (p = 0.21). Histopathological correlation was available in four cases, with two confirmed malignancies. The cancer detection rate was 1.6 per 1000 women screened, the recall rate was 8.5%, and the PPV3 for biopsy was 50%. Conclusion Community-based breast cancer screening using FFDM combined with DBT and synthesised imaging is feasible and clinically effective in an Indian setting. DBT enhances the detection of small and occult lesions, particularly in women with dense breasts. Strengthening follow-up systems and expanding structured, imaging-based screening programmes would significantly improve early detection and outcomes in resource-limited settings.