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Adding tomosynthesis to screening digital mammography decreases the "recall" rate by 15% while increasing the cancer detection rate by 29%, according to a report published online June 25 in JAMA.
Researchers compared the performance of screening digital mammography alone (281,187 cases) against the performance after tomosynthesis was added to mammography (173,663 cases) at 13 sites in geographically diverse regions across the country. The work was funded primarily by Hologic, maker of the only Food and Drug Administration–approved tomosynthesis equipment at the time of this retrospective study, said Dr. Sarah M. Friedewald of the Caldwell Breast Center, Advocate Lutheran General Hospital, Park Ridge, Ill., and her associates.
The "recall" rate – the proportion of patients requiring additional imaging based on the results of their screening mammography – declined from 107 per 1,000 screens with digital mammography alone to 91 per 1,000 screens when tomosynthesis was added, a relative reduction of 15%. At the same time, the cancer detection rate rose from 4.2 to 5.4 per 1,000 scans, a relative increase of 29%. After tomosynthesis was introduced, the detection rate of invasive cancers rose from 2.9 to 4.1 per 1,000 scans, while that of ductal carcinoma in situ remained unchanged at 1.4 per 1,000, the investigators said (JAMA 2014 June 25 [doi:10.1001/jama.2014.6095]).
It is important to note that this study did not assess clinical outcomes, so it remains to be seen whether these improvements in screening mammography translate into clinically relevant improvements in breast cancer mortality. In addition, this study was limited in that it was retrospective and nonrandomized, they wrote.
This study was funded by tomosynthesis equipment maker Hologic and the National Cancer Institute. Dr. Friedewald and her associates also reported other ties to Hologic.
Tomosynthesis likely represents an advance over digital mammography for breast cancer screening, but only appropriately powered, prospective, randomized, multicenter clinical trials involving all four currently available tomosynthesis systems will answer this question definitively, said Dr. Etta D. Pisano and Martin J. Yaffe, Ph.D.
Despite the promising results of Friedewald et al., it is still uncertain whether women should specifically ask for tomosynthesis or whether screening centers should convert to tomosynthesis. People who believe screening mammography saves lives without undue false-positive results and overdiagnosis will likely advocate the addition of tomosynthesis; those who question the utility of screening mammography will not likely change their views after seeing these results, Dr. Pisano and Dr. Yaffe said.
Dr. Pisano is at the Medical University of South Carolina, Charleston. Dr. Yaffe is at the Ontario Institute for Cancer Research at the University of Toronto. Dr. Pisano reported ties to FujiFilm, Koning Corp., Siemens, Philips, and NextRay Inc.; Dr. Yaffe reported ties to GE Healthcare and Mammographic Physics Inc. These remarks were taken from their editorial accompanying Dr. Friedewald’s report (JAMA 2014;311:2488-9).
Tomosynthesis likely represents an advance over digital mammography for breast cancer screening, but only appropriately powered, prospective, randomized, multicenter clinical trials involving all four currently available tomosynthesis systems will answer this question definitively, said Dr. Etta D. Pisano and Martin J. Yaffe, Ph.D.
Despite the promising results of Friedewald et al., it is still uncertain whether women should specifically ask for tomosynthesis or whether screening centers should convert to tomosynthesis. People who believe screening mammography saves lives without undue false-positive results and overdiagnosis will likely advocate the addition of tomosynthesis; those who question the utility of screening mammography will not likely change their views after seeing these results, Dr. Pisano and Dr. Yaffe said.
Dr. Pisano is at the Medical University of South Carolina, Charleston. Dr. Yaffe is at the Ontario Institute for Cancer Research at the University of Toronto. Dr. Pisano reported ties to FujiFilm, Koning Corp., Siemens, Philips, and NextRay Inc.; Dr. Yaffe reported ties to GE Healthcare and Mammographic Physics Inc. These remarks were taken from their editorial accompanying Dr. Friedewald’s report (JAMA 2014;311:2488-9).
Tomosynthesis likely represents an advance over digital mammography for breast cancer screening, but only appropriately powered, prospective, randomized, multicenter clinical trials involving all four currently available tomosynthesis systems will answer this question definitively, said Dr. Etta D. Pisano and Martin J. Yaffe, Ph.D.
Despite the promising results of Friedewald et al., it is still uncertain whether women should specifically ask for tomosynthesis or whether screening centers should convert to tomosynthesis. People who believe screening mammography saves lives without undue false-positive results and overdiagnosis will likely advocate the addition of tomosynthesis; those who question the utility of screening mammography will not likely change their views after seeing these results, Dr. Pisano and Dr. Yaffe said.
Dr. Pisano is at the Medical University of South Carolina, Charleston. Dr. Yaffe is at the Ontario Institute for Cancer Research at the University of Toronto. Dr. Pisano reported ties to FujiFilm, Koning Corp., Siemens, Philips, and NextRay Inc.; Dr. Yaffe reported ties to GE Healthcare and Mammographic Physics Inc. These remarks were taken from their editorial accompanying Dr. Friedewald’s report (JAMA 2014;311:2488-9).
Adding tomosynthesis to screening digital mammography decreases the "recall" rate by 15% while increasing the cancer detection rate by 29%, according to a report published online June 25 in JAMA.
Researchers compared the performance of screening digital mammography alone (281,187 cases) against the performance after tomosynthesis was added to mammography (173,663 cases) at 13 sites in geographically diverse regions across the country. The work was funded primarily by Hologic, maker of the only Food and Drug Administration–approved tomosynthesis equipment at the time of this retrospective study, said Dr. Sarah M. Friedewald of the Caldwell Breast Center, Advocate Lutheran General Hospital, Park Ridge, Ill., and her associates.
The "recall" rate – the proportion of patients requiring additional imaging based on the results of their screening mammography – declined from 107 per 1,000 screens with digital mammography alone to 91 per 1,000 screens when tomosynthesis was added, a relative reduction of 15%. At the same time, the cancer detection rate rose from 4.2 to 5.4 per 1,000 scans, a relative increase of 29%. After tomosynthesis was introduced, the detection rate of invasive cancers rose from 2.9 to 4.1 per 1,000 scans, while that of ductal carcinoma in situ remained unchanged at 1.4 per 1,000, the investigators said (JAMA 2014 June 25 [doi:10.1001/jama.2014.6095]).
It is important to note that this study did not assess clinical outcomes, so it remains to be seen whether these improvements in screening mammography translate into clinically relevant improvements in breast cancer mortality. In addition, this study was limited in that it was retrospective and nonrandomized, they wrote.
This study was funded by tomosynthesis equipment maker Hologic and the National Cancer Institute. Dr. Friedewald and her associates also reported other ties to Hologic.
Adding tomosynthesis to screening digital mammography decreases the "recall" rate by 15% while increasing the cancer detection rate by 29%, according to a report published online June 25 in JAMA.
Researchers compared the performance of screening digital mammography alone (281,187 cases) against the performance after tomosynthesis was added to mammography (173,663 cases) at 13 sites in geographically diverse regions across the country. The work was funded primarily by Hologic, maker of the only Food and Drug Administration–approved tomosynthesis equipment at the time of this retrospective study, said Dr. Sarah M. Friedewald of the Caldwell Breast Center, Advocate Lutheran General Hospital, Park Ridge, Ill., and her associates.
The "recall" rate – the proportion of patients requiring additional imaging based on the results of their screening mammography – declined from 107 per 1,000 screens with digital mammography alone to 91 per 1,000 screens when tomosynthesis was added, a relative reduction of 15%. At the same time, the cancer detection rate rose from 4.2 to 5.4 per 1,000 scans, a relative increase of 29%. After tomosynthesis was introduced, the detection rate of invasive cancers rose from 2.9 to 4.1 per 1,000 scans, while that of ductal carcinoma in situ remained unchanged at 1.4 per 1,000, the investigators said (JAMA 2014 June 25 [doi:10.1001/jama.2014.6095]).
It is important to note that this study did not assess clinical outcomes, so it remains to be seen whether these improvements in screening mammography translate into clinically relevant improvements in breast cancer mortality. In addition, this study was limited in that it was retrospective and nonrandomized, they wrote.
This study was funded by tomosynthesis equipment maker Hologic and the National Cancer Institute. Dr. Friedewald and her associates also reported other ties to Hologic.
FROM JAMA
Key clinical point: Tomosynthesis may reduce the need for repeat imaging to detect breast cancer.
Major finding: The "recall" rate declined from 107 per 1,000 screens with digital mammography alone to 91 per 1,000 screens when tomosynthesis was added, a relative reduction of 15%; at the same time, the cancer detection rate rose from 4.2 to 5.4 per 1,000 scans, a relative increase of 29%.
Data source: A retrospective multicenter analysis of screening digital mammography’s performance before (281,187 scans) and after (173,663 scans) the introduction of tomosynthesis to improve its accuracy.
Disclosures: This study was funded by Hologic and the National Cancer Institute. Dr. Friedewald and her associates also reported other ties to Hologic, which makes tomosynthesis equipment.
