Digital Breast Tomosynthesis Screening Digital breast tomosynthesis (DBT) displays reconstructed stacked images of the breast in combination with digital mammographic views, which may be synthetic mammograms reconstructed from the acquired tomosynthesis data set or full-field digital mammograms (FFDM). Compared to FFDM or synthetic mammograms alone, most studies demonstrate that DBT increases cancer detection rate (CDR) and decreases recall rate [14-22]; although some studies have not reached statistical significance [23] or have found less compelling results in subsets of women, such as those with extremely dense breasts [24,25]. Dense breast tissue decreases the sensitivity of mammography [26] and is an independent risk factor for developing breast cancer [27]. Compared to average breast density (near the threshold between heterogeneously dense and scattered areas of fibroglandular density), the relative risks for developing breast cancer are 1.2 for heterogeneously dense and 2.1 for extremely dense breasts [28]. Some health care providers may therefore consider women with extremely dense breasts to no longer be average risk. Irrespective of risk category, meta-analyses have demonstrated an incremental increase in CDR of 1.6 to 3.2 per 1,000 screening DBT examinations and a 2.2% pooled decrease in recall rate compared to digital mammography [18,29,30]. Because screening mammography decreases breast cancer mortality, screening mammography or screening DBT is still performed in women undergoing supplemental screening studies [3,8,35]. In addition to mortality reduction, screening mammography decreases treatment morbidity, because screen-detected tumors are typically lower stage (eg, smaller and more likely to be node-negative), compared to breast cancers detected by palpation [2,8]. Despite these benefits, screening mammograms also have risks. The most common perceived risks include false-positive recalls and biopsies, overdiagnosis, and patient anxiety [5,7,32].
Female Breast Cancer Screening. Digital Breast Tomosynthesis Screening Digital breast tomosynthesis (DBT) displays reconstructed stacked images of the breast in combination with digital mammographic views, which may be synthetic mammograms reconstructed from the acquired tomosynthesis data set or full-field digital mammograms (FFDM). Compared to FFDM or synthetic mammograms alone, most studies demonstrate that DBT increases cancer detection rate (CDR) and decreases recall rate [14-22]; although some studies have not reached statistical significance [23] or have found less compelling results in subsets of women, such as those with extremely dense breasts [24,25]. Dense breast tissue decreases the sensitivity of mammography [26] and is an independent risk factor for developing breast cancer [27]. Compared to average breast density (near the threshold between heterogeneously dense and scattered areas of fibroglandular density), the relative risks for developing breast cancer are 1.2 for heterogeneously dense and 2.1 for extremely dense breasts [28]. Some health care providers may therefore consider women with extremely dense breasts to no longer be average risk. Irrespective of risk category, meta-analyses have demonstrated an incremental increase in CDR of 1.6 to 3.2 per 1,000 screening DBT examinations and a 2.2% pooled decrease in recall rate compared to digital mammography [18,29,30]. Because screening mammography decreases breast cancer mortality, screening mammography or screening DBT is still performed in women undergoing supplemental screening studies [3,8,35]. In addition to mortality reduction, screening mammography decreases treatment morbidity, because screen-detected tumors are typically lower stage (eg, smaller and more likely to be node-negative), compared to breast cancers detected by palpation [2,8]. Despite these benefits, screening mammograms also have risks. The most common perceived risks include false-positive recalls and biopsies, overdiagnosis, and patient anxiety [5,7,32].