Digital Mammography and Digital Breast Tomosynthesis Performance and Outcomes in Women with a Personal History of Breast Cancer
New BCSC study found that surveillance mammography performance showed minimal improvement over two decades and remained inferior to digital mammography screening benchmarks
The goal of surveillance mammography in breast cancer survivors is the same as screening mammography in women without a breast cancer history—early detection of breast cancer to reduce morbidity and mortality. Compared to women without a breast cancer history, survivors have a greater than 7-times higher risk of subsequent breast cancer. Annual surveillance mammography is recommended for survivors, but mammography is imperfect.
In a study recently published in Radiology, BCSC researchers evaluated whether newer digital mammography and digital breast tomosynthesis have improved diagnostic performance of surveillance mammography. The study included 117,971 mammograms from 32,331 women with treated breast cancer, with 21% from a self-reported minority race or ethnicity group. Study results found little improvement in performance when the more recent digital mammograms and tomosynthesis exams from 2007-2016 were compared to film-screen mammography performance estimates from 1996-2007 and also found lower accuracy when compared with digital screening mammography benchmarks. In particular, interval cancer rates, or cancers diagnosed within a year of a mammogram with negative results, for survivors were more than four times higher compared to the screening population. Approximately 3 in 10 second breast cancers were interval detected and were more likely to have traits associated with worse prognosis than surveillance-detected cancers (>20 mm in size, hormone receptor negative, lymph node positive).
Interval second breast cancers represent a failure to detect an asymptomatic breast cancer—the main goal of surveillance. These results indicate that despite technological advances over the past decade, surveillance mammography has important limitations in detecting second breast cancers and suggest a potential role for targeted supplemental surveillance imaging to improve long-term survival for women after breast cancer treatment.
Full Text Citation and Link: Lee JM, Ichikawa LE, Wernli KJ, Bowles EJA, Specht JM, Kerlikowske K, Miglioretti DL, Lowry KP, Tosteson ANA, Stout NK, Houssami N, Onega T, Buist DSM. Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007–2016. Radiology. 2021. Epub ahead of print. doi.org/10.1148/radiol.2021204581 [Link to Article]
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