Mammographic Screening in Routine Practice: Multisite Study of Digital Breast Tomosynthesis and Digital Mammography Screenings

Background The use of digital breast tomosynthesis (DBT) is increasing over digital mammography (DM) following studies demonstrating lower recall rates (RRs) and higher cancer detection rates (CDRs). However, inconsistent interpretation of evidence on the risks and benefits of mammography has resulted in varying screening mammography recommendations. Purpose To evaluate screening outcomes among women in the United States who underwent routine DM or DBT mammographic screening. Materials and Methods This retrospective cohort study included women aged 40–79 years who underwent DM or DBT screening mammograms between January 2014 and December 2020. Outcomes of RR, CDR, positive predictive value of recall (PPV1), biopsy rate, and positive predictive value of biopsy (PPV3) were compared between DM and DBT with use of adjusted multivariable logistic regression models. Results A total of 2 528 063 screening mammograms from 1 100 447 women (mean age, 57 years ± 10 SD) were included. In crude analyses, DBT (1 693 727 screening mammograms vs 834 336 DM screening mammograms) demonstrated lower RR (10.3% 95% CI: 10.3, 10.4 for DM vs 8.9% 95% CI: 8.9, 9.0 for DBT; P < .001) and higher CDR (4.5 of 1000 screening mammograms 95% CI: 4.3, 4.6 vs 5.3 of 1000 95% CI: 5.2, 5.5; P < .001), PPV1 (4.3% 95% CI: 4.2, 4.5 vs 5.9% 95% CI: 5.7, 6.0; P < .001), and biopsy rates (14.5 of 1000 screening mammograms 95% CI: 14.2, 14.7 vs 17.6 of 1000 95% CI: 17.4, 17.8; P < .001). PPV3 was similar between cohorts (30.0% 95% CI: 29.2, 30.9 for DM vs 29.3% 95% CI: 28.7, 29.9 for DBT; P = .16). After adjustment for age, breast density, site, and index year, associations remained stable with respect to statistical significance. Conclusion Women undergoing digital breast tomosynthesis had improved screening mammography outcomes compared with women who underwent digital mammography. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Bae and Seo in this issue.