Background Digital breast tomosynthesis (DBT) is replacing digital mammography (DM) in the clinical workflow. Currently, there are limited prospective studies comparing the diagnostic accuracy of both examinations and the role of synthetic mammography (SM) and computer-aided detection (CAD). Purpose To compare the accuracy of DM versus DM + DBT in population-based breast cancer screening. Materials and Methods This prospective study, performed from November 2010 to December 2012, included 24 301 women (mean age, 59.1 years ± 5.7 [standard deviation]) with 281 cancers, of which 51 were interval cancers. Each examination was independently interpreted with four reading modes: DM, DM + CAD, DM + DBT, and SM + DBT. Sensitivity and specificity were compared for DM versus DM + DBT, DM versus DM + CAD, DM + DBT versus SM + DBT, and DM versus DM + DBT at double reading. Reader-adjusted performance characteristics of reading modes were evaluated on the basis of pre-arbitration (initial interpretation) scores. Statistical analysis was based on cluster bootstrap analysis using 10 000 random resamples. Results Sensitivity was 54.1% (152 of 281) for DM and 70.5% (198 of 281) for DM + DBT. Reader-adjusted difference was 12.6% (95% confidence interval [CI]: 5.2%, 19.7%; P = .001). Specificity was 94.2% (false-positive fraction [FPF], 5.8%; 1388 of 24 020) for DM and 95.0% (FPF, 5.0%; 1209/24 020) for DM + DBT, with a reader-adjusted difference in FPF of -1.2% (95% CI: -1.7%, -0.7%; P < .001). Sensitivity was 69.0% (194 of 281) for SM + DBT and 70.5% (198 of 281) for DM + DBT, with a reader-adjusted difference of 1.0% (95% CI: -6.2%, 8.5%; P = .77). Specificity was 95.4% (FPF, 4.6%; 1111 of 24 020) for SM + DBT and 95.0% (FPF, 5.0%;1209 of 24 020) for DM + DBT, with reader-adjusted 95% CIs for FPF of 4.7%, 5.4% and 5.0%, 5.7%, respectively, and a difference of -0.3% (95% CI: -0.8%, 0.2%; P = .23). Differences in sensitivity and specificity with the addition of CAD were small and not significant (P > .2). Conclusion Addition of digital breast tomosynthesis to digital mammography resulted in significant gains in sensitivity and specificity. Synthetic mammography in combination with digital breast tomosynthesis had similar sensitivity and specificity to digital mammography in combination with digital breast tomosynthesis. © RSNA, 2019 See also the editorial by Lång in this issue.

Our study showed the rate of screen-detected breast cancer was substantially higher in women who underwent digital breast tomosynthesis and synthetic mammography screening than in women who underwent digital mammography screening. PurposeTo compare the performance of digital breast tomosynthesis (DBT) and two-dimensional synthetic mammography (SM) with that of digital mammography (DM) in a population-based mammographic screening program.Materials and MethodsIn this prospective cohort study, data from 37 185 women screened with DBT and SM and from 61 742 women screened with DM as part of a population-based screening program in 2014 and 2015 were included. Early performance measures, including recall rate due to abnormal mammographic findings, rate of screen-detected breast cancer, positive predictive value of recall, positive predictive value of needle biopsy, histopathologic type, tumor size, tumor grade, lymph node involvement, hormonal status, Ki-67 level, and human epidermal growth factor receptor 2 status were compared in women who underwent DBT and SM screening and in those who underwent DM screening by using χ2 tests, two-sample unpaired t tests, and tests of proportions.ResultsRecall rates were 3.4% for DBT and SM screening ...

Objective: To estimate the cumulative risk of a false-positive screening result in European mammographic screening programmes, and examine the rates and procedures of further assessment. Methods: A literature review was conducted to identify studies of the cumulative risk of a false-positive result in European screening programmes (390,000 women). We then examined aggregate data, cross-sectional information about further assessment procedures among women with positive results in 20 mammographic screening programmes from 17 countries (1.7 million initial screens, 5.9 million subsequent screens), collected by the European Network for Information on Cancer project (EUNICE). Results: The estimated cumulative risk of a false-positive screening result in women aged 50–69 undergoing 10 biennial screening tests varied from 8% to 21% in the three studies examined (pooled estimate 19.7%). The cumulative risk of an invasive procedure with benign outcome ranged from 1.8% to 6.3% (pooled estimate 2.9%). The risk of undergoing surgical intervention with benign outcome was 0.9% (one study only). From the EUNICE project, the proportions of all screening examinations in the programmes resulting in needle biopsy were 2.2% and 1.1% for initial and subsequent screens, respectively, though the rates differed between countries; the corresponding rates of surgical interventions among women without breast cancer were 0.19% and 0.07%. Conclusion: The specific investigative procedures following a recall should be considered when examining the cumulative risk of a false-positive screening result. Most women with a positive screening test undergo a non-invasive assessment procedure. Only a small proportion of recalled women undergo needle biopsy, and even fewer undergo surgical intervention.

The performance of the artificial intelligence system was promising for breast cancer detection in a large population-based mammography screening program. Background Artificial intelligence (AI) has shown promising results for cancer detection with mammographic screening. However, evidence related to the use of AI in real screening settings remain sp...

BACKGROUND: The Norwegian Breast Cancer Screening Program started in 1996. To the authors' knowledge, this is the first report using individual‐based data on invitation and participation to analyze breast cancer mortality among screened and nonscreened women in the program.METHODS: Information on dates of invitation, attendance, breast cancer diagnosis, emigration, death, and cause of death was linked by using unique 11‐digit personal identification numbers assigned all inhabitants of Norway at birth or immigration. In total, 699,628 women ages 50 to 69 years without prior a diagnosis of breast cancer were invited to the program from 1996 to 2009 and were followed for breast cancer through 2009 and death through 2010. Incidence‐based breast cancer mortality rate ratios (MRRs) were compared between the screened and nonscreened cohorts using a Poisson regression model. The MRRs were adjusted for calendar period, attained age, years since inclusion in the cohorts, and self‐selection bias.RESULTS: The crude breast cancer mortality rate was 20.7 per 100,000 women‐years for the screened cohort compared with 39.7 per 100,000 women‐years for the nonscreened cohort, resulting in an MRR of 0.52 (95% confidence interval, 0.47‐0.59). The mortality reduction associated with attendance in the program was 43% (MRR, 0.57; 95% confidence interval, 0.51‐0.64) after adjusting for calendar period, attained age, years after inclusion in the cohort, and self‐selection bias.CONCLUSIONS: After 15 years of follow‐up, a 43% reduction in mortality was observed among women who attended the national mammographic screening program in Norway. Cancer 2013;119:3106–3112. © 2013 American Cancer Society.