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CC BY-NC-ND 4.0 · Senologie - Zeitschrift für Mammadiagnostik und -therapie 2024; 21(03): 219-226
DOI: 10.1055/a-2287-2854
Original Research

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

Article in several languages: English | deutsch
Stefanie Weigel
1   Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
,
Veronika Weyer-Elberich
2   Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
,
Hans-Werner Hense
3   Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
,
Thomas Decker
1   Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
,
Joachim Gerß
4   Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
,
Walter Heindel
1   Clinic for Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
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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

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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