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Table: Summary of Cancer Detection Rates by Screening Method

For every 1000 women screened with 2D mammography, approximately 100 women will be recalled for additional testing and 2-7 women (depending on the age and risk factors of the woman) will be found to have breast cancer [1]

Breast cancer incidence increases as women get older: for women in their 40s, cancer detection rates on mammography are closer to 2 per 1000 and “false positive” recalls are 120-140 per 1000. With increasing age, cancer detection rates increase and false positive recalls decrease (in part because prior mammograms are available for comparison and in part because breasts are less “busy” as women get older). For women over age 75, cancer detection rates average 6-7 per 1000 and false positive recalls average 55-65 per 1000 [1]

With any screening method, false positive recalls (for additional testing for findings that do not prove to be cancer) are almost always reduced when prior examinations are available for comparison, i.e. in subsequent or “incident” screening rounds.

The Table below shows the expected additional cancer detection (in women of different breast density), effect on the false positive recall rate, and type of cancers seen using imaging methods after standard 2D mammography.


Method

Breast Density

Added Cancer Detection

Projected Impact on
False Positive Rate

Types of Cancers Seen

Tomosynthesis (3D mammography)a

Scattered
fibroglandular
density or
Heterogeneously
dense

1-2 per 1000 [1-3]

Overall decrease in false positive recalls to 80 to 90 per 1000;
May drop to 60 to 70 per 1000 after multiple screening rounds (based on a single-center study [5])

The cancers seen only on tomosynthesis are nearly all invasive; greatest detection benefit and shift to smaller, better prognosis cancers seen in women 40-49 years old [6]

Tomosynthesis (3D mammography)a

Extremely dense

Negligible [2,7,8]

No significant reduction in false positive recall rate

Not applicable

Ultrasound (US)
(first round)

Heterogeneously dense or Extremely dense

2-3 per 1000 [9]

Increase in false positive recalls to 170 to 200 per 1000

More than 85% of cancers seen only on US are invasive; 82-90% are node negative [9] (still contained within the breast)

Ultrasound (US)
(subsequent rounds)

Heterogeneously dense or Extremely dense

2-3 per 1000

Increase in false positive recalls to 150 to 170 per 1000 [10,11]

More than 85% of cancers seen only on US are invasive; 82-90% are node negative [9] (still contained within the breast)

Ultrasound vs. tomosynthesis

Heterogeneously dense or Extremely dense

2-3 per 1000
more with US [12,13]

Increase in false positive recalls with USb

 

MRI
(first round)

Extremely dense

16 per 1000 [14]

Increase in false positive recalls to 178 per 1000

13 per 1000 invasive cancer yield (3 per 1000 are non-invasive, i.e. DCIS) seen only on MRI

MRI
(subsequent rounds)

Extremely dense

6 per 1000 [15]

Increase in false positive recalls to 127 per 1000

4 per 1000 invasive cancer yield (2 per 1000 are non-invasive, i.e. DCIS) seen only on MRI

Abbreviated (“fast” or “mini”) MRI after tomosynthesisc

Heterogeneously dense or Extremely dense

10 per 1000 [16]

Increase in false positive recalls: 133 per 1000 for MRI vs. 26 per 1000 for tomosynthesis

7 per 1000 invasive cancer yield (3 per 1000 are non-invasive) seen only on MRI in first round of screening

© DenseBreast-info.org and Dr. Wendie Berg

DCIS = ductal carcinoma in situ

a In many centers, a “standard” 2D mammogram can be created from the same projection images used to generate the tomosynthesis (“synthetic” 2D mammogram) so that there is no added radiation or second exposure for the 2D mammogram.

b In the Italian multicenter ASTOUND-2 trial, ultrasound increased recalls more than tomosynthesis (1.0% vs. 0.3%) after a negative 2D mammogram, but recall rates are not comparable to those in the United States.

c In this prospective trial across 48 centers in the United States and Germany, abbreviated MRI was compared to tomosynthesis (3D mammography).

References Cited:

1. Lee CS, Sengupta D, Bhargavan-Chatfield M, Sickles EA, Burnside ES, Zuley ML. Association of Patient Age With Outcomes of Current-Era, Large-Scale Screening Mammography: Analysis of Data From the National Mammography Database. JAMA oncology 2017; 3:1134-1136

2. 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

3. Skaane P, Bandos AI, Niklason LT, et al. Digital Mammography versus Digital Mammography Plus Tomosynthesis in Breast Cancer Screening: The Oslo Tomosynthesis Screening Trial. Radiology 2019; 291:23-30

4. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA 2014; 311:2499-2507

5. Conant EF, Zuckerman SP, McDonald ES, et al. Five Consecutive Years of Screening with Digital Breast Tomosynthesis: Outcomes by Screening Year and Round. Radiology 2020:191751

6. Conant EF, Barlow WE, Herschorn SD, et al. Association of Digital Breast Tomosynthesis vs Digital Mammography With Cancer Detection and Recall Rates by Age and Breast Density. JAMA oncology 2019; 5:635-642

7. Yi A, Chang JM, Shin SU, et al. Detection of noncalcified breast cancer in patients with extremely dense breasts using digital breast tomosynthesis compared with full-field digital mammography. Br J Radiol 2018:20180101

8. Osteras BH, Martinsen ACT, Gullien R, Skaane P. Digital Mammography versus Breast Tomosynthesis: Impact of Breast Density on Diagnostic Performance in Population-based Screening. Radiology 2019; 293:60-68

9. Berg WA, Vourtsis A. Screening breast ultrasound using hand-held or automated technique in women with dense breasts. J Breast Imaging 2019; 1:283-296

10. Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012; 307:1394-1404

11. Weigert JM. The Connecticut Experiment; The Third Installment: 4 Years of Screening Women with Dense Breasts with Bilateral Ultrasound. Breast J 2017; 23:34-39

12. Tagliafico AS, Calabrese M, Mariscotti G, et al. Adjunct Screening With Tomosynthesis or Ultrasound in Women With Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial. J Clin Oncol 2016; 34:1882-1888

13. Tagliafico AS, Mariscotti G, Valdora F, et al. A prospective comparative trial of adjunct screening with tomosynthesis or ultrasound in women with mammography-negative dense breasts (ASTOUND-2). Eur J Cancer 2018; 104:39-46

14. Bakker MF, de Lange SV, Pijnappel RM, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med 2019; 381:2091-2102

15. Bakker MF, deLange SV, Pijnappel RM, et al. MRI in addition to mammography screening in women with extremely dense breasts: Primary outcome of the randomized DENSE trial. In: Radiologic Society of North America. Chicago, IL, 2019

16. Comstock CE, Gatsonis C, Newstead GM, et al. Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA 2020; 323:746-756

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