A pioneering 10-year study has shown that digital breast tomosynthesis (DBT) greatly enhances breast cancer detection and lowers advanced cancer rates compared to conventional mammography. This groundbreaking research, published in Radiology, highlights the potential of DBT to revolutionize breast cancer screening.
In a major advancement in breast cancer screening, a 10-year study has confirmed the superiority of digital breast tomosynthesis (DBT) over conventional 2D digital mammography in detecting breast cancer earlier and reducing the rate of advanced-stage disease. The research, published today in Radiology, underscores the potential for DBT to become the new standard in breast cancer screening.
Mammography has long been the gold standard for breast cancer screening. Traditional 2D digital mammography, which involves taking X-ray images from two angles, misses approximately 20% of breast cancers and often results in false positives — cases where an abnormality appears suspicious but is ultimately non-cancerous, leading to unnecessary additional tests and anxiety.
DBT, an advanced form of mammography, creates a 3D reconstruction of the breast by taking multiple images from different angles. Previous studies have pointed to its higher cancer detection rate compared to traditional mammography, but this new study is the first to provide a decade’s worth of comparative data.
“This study is the first to compare 10 years of data on breast cancers detected by DBT to digital mammography-detected cancers,” co-author Jaskirandeep Kaur Grewal, previously a student at Yale School of Medicine Physician Associate Program, said in a news release.
Conducted by Liane Elizabeth Philpotts and her team at Yale University/Yale-New Haven Health, the retrospective study analyzed 272,938 screening mammograms over 13 years. The cohort included 35,544 digital mammograms from before 2011 and 237,394 DBT mammograms from 2011 onwards. The analysis revealed a total of 1,407 cancers — 142 detected by mammography and 1,265 by DBT.
“Overdiagnosis has been a hot topic in mammography screening. Skeptics of mammography screening believe that the use of DBT results in overdiagnosis,” Philpotts, a professor of radiology and biomedical imaging at Yale School of Medicine and the first co-author of the study, said in the news release.
Overdiagnosis refers to the identification of cancers that are not clinically significant and would not affect the patient’s health if left undiagnosed.
The study found no significant difference in the ratio of invasive cancers to ductal carcinoma in situ (DCIS) between DBT and digital mammography, suggesting that both techniques detect similar cancer types. However, DBT was more effective at identifying aggressive cancers early on.
“We found that digital mammography and DBT screening mammography found the same types of cancers, but at different stages,” Philpotts added. “DBT found more aggressive cancers at an earlier stage compared to digital mammography.”
Furthermore, DBT demonstrated a higher cancer detection rate (5.3%) compared to digital mammography (4.0%) and a lower rate of advanced cancers (32.7% versus 43.6%). This indicates that cancers are more likely being detected at a less advanced, more treatable stage with DBT, which is crucial for improving patient outcomes.
Notably, the recall rate for DBT (7.2%) was significantly lower than that for digital mammography (10.6%), meaning fewer women were called back for additional testing due to false positives.
“DBT’s lower recall rate, higher cancer detection rate and lower rate of advanced cancers is a win, win, win,” added Philpotts. “I think this data will contribute to the debate of overdiagnosis by demonstrating that DBT is not over-diagnosing cancers. It’s finding the bad actors earlier.”
While these findings are promising, Philpotts emphasized the need for further long-term studies to better understand DBT’s role in screening outcomes.
“Our results may provide health care institutions that have not yet switched from digital mammography to DBT with the data they need to adopt the newer technology,” she said.
This study is a significant milestone in the evolving landscape of breast cancer screening, potentially paving the way for DBT to become the preferred method, offering women more accurate and earlier detection of breast cancers, ultimately saving lives.