Q&A: When to use digital breast tomosynthesis for cancer screening
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Key takeaways:
- Mammography and digital breast tomosynthesis have very similar benefits and drawbacks.
- When deciding on a screening modality, PCPs should consider factors like family history and breast density.
Mammography and digital breast tomosynthesis lead to very similar outcomes, so shared-decision making is important for breast cancer screening, according to an expert.
The choice of when and how to screen for breast cancer can be a complex one for many people. Major medical organizations have conflicting clinical guidelines, and other factors — like family history and breast density — are also important factors to consider.
Anna N. A. Tosteson, ScD, a professor of oncology and community and family medicine at the Dartmouth University Geisel School of Medicine, and colleagues conducted a model-based comparative effectiveness analysis to evaluate projected long-term outcomes for two breast cancer mammography screening strategies — digital mammography or digital breast tomosynthesis (DBT) — by breast density.
Healio spoke with Tosteson, who is also associate director for population sciences at the Dartmouth Cancer Center, about the study and what PCPs need to know.
Healio: Why did you decide to compare these screening approaches?
Tosteson: We did this study because the limitations of mammography screening for women with mammographically dense breast tissue have been recognized. Also, the U.S. Preventive Services Task Force recently concluded in their 2024 breast cancer screening guidelines update that there was inconclusive evidence to make recommendations on supplemental screening for women with dense breasts at average breast cancer risk. This, combined with the fact that women in the United States who undergo mammography screening will soon be notified of their breast density, made it an opportune time to undertake a simulation study to characterize the expected benefit vs. harm tradeoffs for digital mammography, DBT and supplemental MRI screening in average risk women.
Healio: What are the pros and cons of DBT screening?
Tosteson: The pros and cons of DBT screening parallel those of mammography. Individual women’s experience of breast cancer screening with either modality will be similar. Both modalities involve breast compression. DBT is associated with fewer false-positive recalls than digital mammography and a similar number of deaths averted.
Healio: Who should be screened and why? What factors should PCPs consider when deciding which screening type is best for their patients?
Tosteson: Breast cancer screening is something that all women aged 40 years and older should learn about and discuss with their PCP. There are several breast cancer screening shared decision-making tools that may be helpful for educating women about breast cancer screening decisions. As an example, my colleague, Dr. Christine Gunn, has developed the online myMammogram decision aid for women aged 40 to 55 years about when to start breast cancer screening with mammography.
Typical factors that PCPs consider are individual women’s breast cancer risk — for example, is there a family history of breast cancer — and their breast density, which would be known only if they’ve previously undergone mammography or DBT screening.
Healio: What is the take-home message for PCPs?
Tosteson: DBT and mammography screening are associated with very similar outcomes. For women with extremely dense breasts, use of supplemental MRI every other year may be considered. Our analysis definitely highlighted the benefit-to-harm tradeoffs with a marked increase in false-positive recall and biopsy recommendations when supplemental MRI was used in all women with dense breasts rather than only those with extremely dense breasts.
Healio: Is there anything else you would like to add?
Tosteson: Our analysis pertains only to average risk women.