Increased detection of relevant breast cancers with DBT in mammography screening?

Abstract

Introduction

Screening with digital breast tomosynthesis plus synthetic mammography (DBT+SM) increases invasive breast cancer detection compared to digital mammography (DM). Since a reduction in breast cancer mortality is largely based on the detection of histological grade 2 or 3 breast cancers, a comparison of the detection rates of invasive breast cancers (iCDR), independent of the stage, of grades 2 or 3, was carried out, taking into account breast density, after screening with DBT+SM vs. DM.

Material and Methods

The 1:1 randomized, multicenter TOSYMA study recruited participants from 7/2018 to 12/2020 in the German Mammography Screening Program. This explorative subanalysis included 49479 participants in the DBT+SM arm and 49689 participants in the DM arm, with complete documentation including visual density categorization (A/B: non-dense parenchyma, C/D: dense parenchyma).

Results

The iCDR of grade 2 or 3 was 5.1 per 1000 women screened with DBT+SM vs. 3.6 ‰ screened with DM (difference +1.5 ‰). In the case of non-dense parenchyma, the corresponding DBT+SM rate was 4.5 ‰ (difference to DM +1.3 ‰), and in dense parenchyma it was 5.7 ‰ (difference to DM +1.7 ‰).

The iCDR of grade 1 was 2.1 ‰ with DBT+SM (difference to DM +0.8 ‰). In non-dense parenchyma, the corresponding DBT+SM rate was 1.7 ‰ (difference to DM +0.7 ‰), in dense parenchyma it was 2.6 ‰ (difference to DM +1.0 ‰).

Conclusion

When screening with DBT+SM, invasive breast cancer detection rates of grade 2 or 3 tumors are higher than with DM. Detection rates and their differences are also higher in women with dense than non-dense parenchyma. These detection rates and their differences are consistently higher for DBT+SM and DM than those for grade 1 cancers. The explorative analyses of this large, randomized trial indicate that DBT+SM screening increases the detection of prognostically more relevant breast cancers.

Keywords

Breast cancer - mammography screening - digital breast tomosynthesis - breast density - tumor grade

Publication History

Article published online:
13 September 2024

• References

• 1 Lauby-Secretan B, Scoccianti C, Loomis D. et al. Breast-cancer screening--viewpoint of the IARC Working Group. N Engl J Med 2015; 372: 2353-2358
• 2 Marmot MG, Altman DG, Cameron DA. et al. The benefits and harms of breast cancer screening: an independent review. Br J Cancer 2013; 108: 2205-2240
• 3 Waldmann A, Hübner J, Katalinic A. Trends Over Time in Breast-Cancer-Specific Mortality in Germany. Dtsch Arztebl Int 2021; 118: 538-539
• 4 Perry N, Broeders M, de Wolf C. et al. European guidelines for quality assurance in breast cancer screening and diagnosis. 4th edn. Luxembourg: Office for Official Publications of the European Communities; 2006.
• 5 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249
• 6 Chong A, Weinstein SP, McDonald ES. et al. Digital breast tomosynthesis: concepts and clinical practice. Radiology 2019; 292: 1-14
• 7 Weigel S, Gerss J, Hense HW. et al. Digital breast tomosynthesis plus synthesised images vs. standard full-field digital mammography in population-based screening (TOSYMA): protocol of a randomised controlled trial. BMJ Open 2018;
• 8 Heindel W, Weigel S, Gerß J. et al. Digital breast tomosynthesis plus synthesised mammography vs. digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol 2022; 23: 601-611
• 9 Weigel S, Heindel W, Decker T. et al. TOSYMA Screening Trial Study Group. Digital Breast Tomosynthesis vs. Digital Mammography for Detection of Early-Stage Cancers Stratified by Grade: A TOSYMA Subanalysis. Radiology 2023; 309 (03) e231533
• 10 Arpino G, Milano M, De Placido S. Features of aggressive breast cancer. Breast 2015; 24: 594-600
• 11 Tabar L, Chen TH, Yen AM. et al. Effect of Mammography Screening on Mortality by Histological Grade. Cancer Epidemiol Biomarkers Prev 2018; 27: 154-157
• 12 Kerin EP, Davey MG, McLaughlin RP. et al. Comparison of the Nottingham Prognostic Index and OncotypeDX(c) recurrence score in predicting outcome in estrogen receptor positive breast cancer. Breast 2022; 66: 227-235
• 13 Lemij AA, Baltussen JC, de Glas NA. et al. Gene expression signatures in older patients with breast cancer: A systematic review. Crit Rev Oncol Hematol 2023; 181: 103884
• 14 Sparano JA, Crager MR, Tang G. et al. Development and Validation of a Tool Integrating the 21-Gene Recurrence Score and Clinical-Pathological Features to Individualize Prognosis and Prediction of Chemotherapy Benefit in Early Breast Cancer. J Clin Oncol 2021; 39: 557-564
• 15 Taylor C, McGale P, Probert J. et al. Breast cancer mortality in 500 000 women with early invasive breast cancer diagnosed in England, 1993–2015: population based observational cohort study. BMJ 2023; 381: e074684
• 16 Weigel S, Heindel W, Hense HW. et al. TOSYMA Screening Trial Study Group. Breast Density and Breast Cancer Screening with Digital Breast Tomosynthesis: A TOSYMA Trial Subanalysis. Radiology 2023; 306 (02) e221006
• 17 Weigel S, Hense HW, Weyer-Elberich V. et al. Breast cancer screening with digital breast tomosynthesis: Is independent double reading still required?. Rofo 2024; 196 (08) 834-842
• 18 D’Orsi CJ, Sickles EA, Mendelson EB. et al. ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. 5th ed. Reston: VA: American College of Radiology; 2013
• 19 Lee CH, Destounis SV, Friedewald SM. et al. DIGITAL BREAST TOMOSYNTHESIS (DBT) GUIDANCE, A supplement to ACR BI-RADS Atlas, Breast Imaging Reporting and Data System. 5th ed. Reston: VA: American College of Radiology; 2013
• 20 Rakha EA, El-Sayed ME, Lee AH. et al. Prognostic significance of Nottingham histologic grade in invasive breast carcinoma. J Clin Oncol 2008; 26: 3153-3158
• 21 Autier P, Boniol M, Koechlin A. et al. Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. BMJ 2017; 5: 359
• 22 Puliti D, Duffy SW, Miccinesi G. et al. EUROSCREEN Working Group. Overdiagnosis in mammographic screening for breast cancer in Europe: a literature review. J Med Screen 2012; 19: 42-56
• 23 Perry N, Broeders M, de Wolf C. et al. European guidelines for quality assurance in breast cancer screening and diagnosis. 4th ed. Luxembourg: Office for Official Publications of the European Communities; 2006
• 24 Krishnamurti UG, Fitzgibbons PL, Connolly JL. College of American Pathologists - Protocol for the Examination of Biopsy Specimens from Patients with Invasive Carcinoma of the Breast Cancer Protocol Templates. Accessed April 25, 2024 at: https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates
• 25 Henson DE, Ries L, Freedman LS. et al. Relationship among outcome, stage of disease, and histologic grade for 22,616 cases of breast cancer. The basis for a prognostic index. Cancer 1991; 68: 2142-2149
• 26 Warwick J, Tabar L, Vitak B. et al. Time-dependent effects on survival in breast carcinoma: results of 20 years of follow-up from the Swedish Two-County Study. Cancer 2004; 100: 1331-1336
• 27 Rafferty EA, Durand MA, Conant EF. et al. Breast cancer screening using tomosynthesis and digital mammography in dense and nondense breasts. JAMA 2016; 315: 1784-1786
• 28 Østerås BH, Martinsen ACT, Gullien R. et al. Digital mammography vs. breast tomosynthesis: impact of breast density on diagnostic performance in population-based screening. Radiology 2019; 293: 60-68