Digital Breast Tomosynthesis Screening 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 FFDM. Compared to FFDM or synthetic mammograms alone, most studies demonstrate that DBT increases 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]. 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]. Within the limited studies of women at elevated risk due to personal and/or family history of breast cancer, DBT decreased recall rate without a significant increase in CDR compared to FFDM; however, small sample sizes restrict analyses [3,40]. High-risk women should begin annual screening mammography at 30 years of age or 10 years prior to the youngest family member who had breast cancer, but generally not before 30 years of age [3]. Approximately one-third of breast cancers may only be detected on mammography in BRCA2 mutation carriers who are <40 years of age [79]. In some mutation carriers, some referring providers use mammography or DBT beginning at 40 years of age if patients undergo annual MRI [80]. Women who underwent thoracic or upper abdominal radiation therapy at an early age (<30 years) should begin screening mammography 8 years after radiation therapy but not before 25 years of age [3]. Because screening mammography decreases breast cancer mortality, screening mammography or screening DBT is still performed in women undergoing supplemental screening studies [3,8,35].
Female Breast Cancer Screening. Digital Breast Tomosynthesis Screening 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 FFDM. Compared to FFDM or synthetic mammograms alone, most studies demonstrate that DBT increases 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]. 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]. Within the limited studies of women at elevated risk due to personal and/or family history of breast cancer, DBT decreased recall rate without a significant increase in CDR compared to FFDM; however, small sample sizes restrict analyses [3,40]. High-risk women should begin annual screening mammography at 30 years of age or 10 years prior to the youngest family member who had breast cancer, but generally not before 30 years of age [3]. Approximately one-third of breast cancers may only be detected on mammography in BRCA2 mutation carriers who are <40 years of age [79]. In some mutation carriers, some referring providers use mammography or DBT beginning at 40 years of age if patients undergo annual MRI [80]. Women who underwent thoracic or upper abdominal radiation therapy at an early age (<30 years) should begin screening mammography 8 years after radiation therapy but not before 25 years of age [3]. Because screening mammography decreases breast cancer mortality, screening mammography or screening DBT is still performed in women undergoing supplemental screening studies [3,8,35].