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Journal ArticleDOI

A randomised trial of screening with digital breast tomosynthesis plus conventional digital 2D mammography versus 2D mammography alone in younger higher risk women.

01 Sep 2017-European Journal of Radiology (Elsevier)-Vol. 94, pp 133-139

TL;DR: The addition of DBT to 2D mammography in incident screening did not lead to a significant reduction in recall rate, and DBT may increase reader uncertainty until DBT screening experience is acquired.
Abstract: Introduction Digital breast tomosynthesis (DBT) has been shown to increase invasive cancer detection rates at screening compared to full field digital (2D) mammography alone, and some studies have reported a reduction in the screening recall rate. No prospective randomised studies of DBT have previously been published. This study compares recall rates with 2D mammography with and without concurrent DBT in women in their forties with a family history of breast cancer undergoing incident screening. Materials and methods Asymptomatic women aged 40–49 who had previously undergone mammography for an increased risk of breast cancer were recruited in two screening centres. Participants were randomised to screening with 2D mammography only at the first study screen followed a year later by screening with 2D plus DBT, or vice versa. Recall rates were compared using an intention to treat analysis. Reading performance was analysed for the larger centre. Results 1227 women were recruited. 1221 first screens (604 2D, 617 2D + DBT) and 1124 second screens (558 2D + DBT, 566 2D) were analysed. Eleven women had screen-detected cancers: 5 after 2D, 6 after 2D + DBT. The false positive recall rates were 2.4% for 2D and 2.2% for 2D + DBT (p = 0.89). There was a significantly greater reduction between rounds in the number of women with abnormal reads who were not recalled after consensus/arbitration with 2D + DBT than 2D (p = 0.023). Conclusion The addition of DBT to 2D mammography in incident screening did not lead to a significant reduction in recall rate. DBT may increase reader uncertainty until DBT screening experience is acquired.
Topics: Mammography (60%), Breast cancer (52%)

Summary (3 min read)

INTRODUCTION

  • In recent years digital breast tomosynthesis (DBT) has become established as a useful adjunct to, and in some centres a replacement for, conventional full-field digital mammography (FFDM).
  • Imaging the breast with DBT as a stack of contiguous thin (usually 1 mm thick) slices allows separation of overlying opacities, thus making cancers more obvious and resolving composite densities.
  • Several large trials together with in-service observational studies have demonstrated a significantly higher sensitivity of combined FFDM and DBT compared to FFDM alone together with the potential to reduce the false positive rate [1].
  • False positive rates in the UK National Health Service Breast Screening Programme are more common in women undergoing a first screen than those undergoing repeat (incident screening) (7.9% v. 3.0% [6]), as the lack of a prior mammogram for comparison can increase uncertainty about benign glandular densities.
  • These younger women are often anxious because of their increased breast cancer risk [7], and measures which potentially reduce the need for recall in this group are worthy of investigation.

Trial design

  • The primary study was a prospective parallel group study of asymptomatic women undergoing two rounds of incident screening a year apart, conducted in two large UK breast screening centres.
  • The study utilised a crossover design with 1:1 block randomisation to either conventional 2-dimensional full-field digital mammography alone (hereafter referred to as 2D mammography) or 2D mammography plus digital breast tomosynthesis (referred to as 2D+DBT), stratified by centre.
  • The crossover at the second screen was to give equitable access to DBT and to reduce disparities in the radiation dose which participants received within the study.
  • Recruitment of these women was terminated in the second year of the trial due to futility.
  • The trial was approved by the UK National Research Ethics Service (North West - Greater Manchester West committee).

Participants

  • Asymptomatic women aged 40 to 49 years previously assessed in a family history clinic (FHC) as being at moderate or high risk of breast cancer as defined by NICE (the National Institute for Health and Care Excellence) [8].
  • The authors have previously demonstrated an expected survival benefit of screening in this group [9].
  • Some previously screened women were scheduled only for mammography due to clinic capacity limitations.
  • Eligible women were identified from NBSS and sent an invitation letter and participant information leaflet with the mammogram appointment.
  • Recruitment in Centre A was from April 2014 to August 2015 and in Centre B from September 2014 to November 2015.

Randomisation

  • Randomisation was performed after written informed consent using a commercial webbased randomisation service (www.sealedenvelope.com).
  • The participant’s study number   8 was the sole identifier.
  • Randomisation was with random permuted blocks within the strata with stratification by study site.
  • The outcome of the randomisation was displayed on the web page and was manually recorded on the clinic list.
  • The date, participant’s age at entry, trial centre, screen type (prevalent or incident), whether the woman was also undergoing annual screening MRI and the assigned first examination for randomised incident women were entered.

Interventions

  • Mammography was performed on Hologic Selenia Dimensions machines.
  • Those undergoing incident screening were randomised to undergo either 2D mammography alone or 2D+DBT as the first examination.
  • All readers underwent prior training in DBT image interpretation, either through participation in the TOMMY trial [11] or through attendance at an NHSBSPapproved DBT course.
  • Where there was disagreement in the final opinion, a consensus discussion took place between the readers, with arbitration by a third reader if necessary.
  • The findings at assessment were recorded, together with whether needle biopsy was performed.

Outcomes

  • The primary outcome measure for participants undergoing incident screening at trial entry was the recall rate for further assessment with 2D mammography and 2D+DBT respectively.
  • For participants undergoing prevalent screening at trial entry, the planned primary outcome measure was the recall rate for further assessment.
  • Planned secondary outcome measures included cancer detection rates and individual reader recall rates.
  • For prevalent screens it was intended to examine the number of women whose 2D mammograms were regarded as abnormal (recorded prior to viewing the DBT images) relative to the overall decision based on viewing the 2D+DBT images together.

Sample size

  • These were based on historic data from Centre A. Incident screening: A 7% recall rate was anticipated for incident screening with FFDM alone, reducing to 4.9% with the addition of DBT.
  • For 90% power to detect a difference of this magnitude as significant using McNemar or conditional logistic regression estimates (5% level, two-sided testing) would require 1305 women and 2610 screens.
  • An 11.5% recall rate was anticipated for prevalent screening with FFDM alone, reducing to 8% with the addition of DBT.
  • These numbers were insufficient for a comparative trial with adequate power, hence a single arm study of combined 2D+DBT was performed.
  • A study size of 528 would give approximately 80% power for a one-sample test of these recall rates with an expected confidence interval of less than 2.3% in either direction.

Statistical methods

  • A generalised estimating equation regression model with an exchangeable correlation structure was used to compare recall and biopsy rates between 2D only and 2D+DBT examination strategies.
  • This analysis accounted appropriately for the crossover design of the study, namely, each woman was examined using either 2D only or 2D+DBT at the first of two incident screening rounds and by the alternative examination strategy at the second incident screening round.
  • Differences between sites (Centres A and B) and the effect of the order of the examination strategy were also assessed.
  • Analysis was by intention to treat (i.e. by randomised examination strategy allocation).

Incident screening

  • A total of 1227 women were recruited and randomised, 608 to 2D mammography only at first screen and 619 to 2D+DBT.
  • Two women were randomised to 2D+DBT but incorrectly underwent 2D mammography only as the first study examination (both had 2D+DBT at the second screen).
  • Table 1 shows the number of women screened, the number of cancers detected and the number of false positive recalls in each arm.
  • There was no difference between the groups for either the overall recall rates or the false positive recall rates (2D 2.8% and 2.4%, 2D+DBT 2.7% and 2.2%; Table 2).
  • The corresponding numbers for Centre B are 1 after 2D and 2 after 2D+DBT.

Prevalent screening

  • Table 4 shows the number of women recalled for further assessment.
  • None of these women were diagnosed with breast cancer.
  • No further analysis has been performed due to the low numbers.

DISCUSSION

  • There is now a substantial body of published literature which demonstrates that digital breast tomosynthesis has a higher sensitivity for cancer detection than conventional full field digital mammography alone [13] [14] [15] [16] [17] [18].
  • Many of the studies that have shown a reduced recall rate with DBT had a higher recall rate with 2D mammography than ours [16] [23] [24] [26] [27] [28] and thus had a larger proportion of women who could potentially benefit.
  • This was despite the fact that all readers were trained in DBT and almost all had experience of using it routinely in screening assessment prior to the start of the study.
  • This ‘learning curve’ effect did not have a significant impact upon the false positive recall rate in their study due to the routine use of consensus discussion of   17 cases where the readers disagreed, together with arbitration by a third reader when necessary.
  • The potential remains for DBT to reduce the recall rate at prevalent screening, but this question has yet to be answered.

CONFLICT OF INTEREST STATEMENT

  • The authors confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.

TABLES

  • 14/428 (3.3%; 2.0% - 5.4%) 22/438 (5.0%; 3.3% - 7.5%) p=0.20 Second study screen.
  • 12/401 (3.0%; 1.7% - 5.2%) 8/401 (2.0%; 1.0% - 3.9%) p=0.36.

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The University of Manchester Research
A randomised trial of screening with digital breast
tomosynthesis plus conventional digital 2D mammography
versus 2D mammography alone in younger higher risk
women
DOI:
10.1016/j.ejrad.2017.06.018
Document Version
Accepted author manuscript
Link to publication record in Manchester Research Explorer
Citation for published version (APA):
Maxwell, A., Michell, M., Lim, Y., Astley, S., Wilson, M., Hurley, E., Evans, D., Howell, A., Iqbal, A., Kotre , J.,
Duffy, S., & Morris, J. (2017). A randomised trial of screening with digital breast tomosynthesis plus conventional
digital 2D mammography versus 2D mammography alone in younger higher risk women. European Journal of
Radiology. https://doi.org/10.1016/j.ejrad.2017.06.018
Published in:
European Journal of Radiology
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Download date:10. Aug. 2022

Accepted Manuscript
Title: A randomised trial of screening with digital breast
tomosynthesis plus conventional digital 2D mammography
versus 2D mammography alone in younger higher risk women
Authors: Anthony J. Maxwell, Michael Michell, Yit Y. Lim,
Susan M. Astley, Mary Wilson, Emma Hurley, D. Gareth
Evans, Anthony Howell, Asif Iqbal, John Kotre, Stephen
Duffy, Julie Morris
PII: S0720-048X(17)30273-5
DOI: http://dx.doi.org/doi:10.1016/j.ejrad.2017.06.018
Reference: EURR 7878
To appear in: European Journal of Radiology
Received date: 8-6-2017
Revised date: 22-6-2017
Accepted date: 26-6-2017
Please cite this article as: Maxwell Anthony J, Michell Michael, Lim Yit Y, Astley
Susan M, Wilson Mary, Hurley Emma, Evans D Gareth, Howell Anthony, Iqbal
Asif, Kotre John, Duffy Stephen, Morris Julie.A randomised trial of screening with
digital breast tomosynthesis plus conventional digital 2D mammography versus 2D
mammography alone in younger higher risk women.European Journal of Radiology
http://dx.doi.org/10.1016/j.ejrad.2017.06.018
This is a PDF file of an unedited manuscript that has been accepted for publication.
As a service to our customers we are providing this early version of the manuscript.
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1
A randomised trial of screening with digital breast tomosynthesis plus conventional
digital 2D mammography versus 2D mammography alone in younger higher risk
women
Anthony J Maxwell
a,b*
anthony.maxwell@manchester.ac.uk, Michael Michell
c
michael.michell@nhs.net, Yit Y Lim
a
yit.lim@uhsm.nhs.uk, Susan M Astley
b,a
sue.astley@manchester.ac.uk, Mary Wilson
a
mary.wilson@uhsm.nhs.uk, Emma Hurley
a
,
emma.hurley@uhsm.nhs.uk, D Gareth Evans
a,d
, gareth.evans@cmft.nhs.uk, Anthony
Howell
a,e
tony.howell@ics.manchester.ac.uk, Asif Iqbal
c
asif.iqbal@nhs.net, John Kotre
f
kotre@hotmail.co.uk, Stephen Duffy
g
s.w.duffy@qmul.ac.uk, Julie Morris
h,I
julie.morris@manchester.ac.uk
a
Nightingale Centre, University Hospital of South Manchester, Manchester, M23 9LT, UK
b
Division of Informatics Imaging & Data Sciences, School of Health Sciences, University of
Manchester, Manchester, M13 9PT, UK
c
Breast Radiology Department, King's College Hospital, London, SE5 9RS, UK
d
Genomic Medicine, Manchester Academic Health Sciences Centre, University of
Manchester and Central Manchester Foundation Trust, Manchester M13 9WL, UK
e
Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical
Sciences, University of Manchester, Manchester, M20 4QL, UK
f
Christie Medical Physics and Engineering, The Christie NHS Foundation Trust,
Manchester, M20 4BX, UK
g
Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and
Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
h
Medical Statistics, University Hospital of South Manchester, Manchester, M23 9LT, UK
i
Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester,
M13 9PL, UK
*
Corresponding author

2
Highlights
2DmammographyplusDBTdidnotreducefalsepos itiverateatincidentscreening
DBTinitiallyincreasedreaderuncertainty
EffectofDBTonfalsepositiverateatprevalentscreeningremainsuncertain


3
ABSTRACT
Introduction: Digital breast tomosynthesis has been shown to increase invasive cancer
detection rates at screening compared to full field digital (2D) mammography alone, and
some studies have reported a reduction in the screening recall rate. No prospective
randomised studies of DBT have previously been published. This study compares recall
rates with 2D mammography with and without concurrent DBT in women in their forties with
a family history of breast cancer undergoing incident screening.
Materials and methods: Asymptomatic women aged 40 to 49 who had previously undergone
mammography for an increased risk of breast cancer were recruited in two screening
centres. Participants were randomised to screening with 2D mammography only at the first
study screen followed a year later by screening with 2D plus DBT, or vice versa. Recall rates
were compared using an intention to treat analysis. Reading performance was analysed for
the larger centre.
Results: 1227 women were recruited. 1221 first screens (604 2D, 617 2D+DBT) and 1124
second screens (558 2D+DBT, 566 2D) were analysed. Eleven women had screen-detected
cancers: 5 after 2D, 6 after 2D+DBT. The false positive recall rates were 2.4% for 2D and
2.2% for 2D+DBT (p=0.89). There was a significantly greater reduction between rounds in
the number of women with abnormal reads who were not recalled after consensus /
arbitration with 2D+DBT than 2D (p=0.023).
Conclusion: The addition of DBT to 2D mammography in incident screening did not lead to a
significant reduction in recall rate. DBT may increase reader uncertainty until DBT screening
experience is acquired.
Keywords: Breast cancer; Digital breast tomosynthesis (DBT); Digital mammography;
Screening; Recall rate; Family history

Citations
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01 Jan 2006
TL;DR: User experience surveys (UESs) are regarded as an important part of the overall performance framework for social care and, providing councils with information about how they might improve services locally, and are required to submit their results to government bodies so that the relative performance of the CSSRs can be judged.
Abstract: For some time now councils with social services responsibilities (CSSRs) have been required to conduct surveys of user’s experience of social services. These have taken place nationally in three-yearly cycles. In 2002/03 the survey was for older people, in 2003/04 it was for younger adults with physical and sensory impairments, and in 2004/05 it was for children. 2005/06 marked the beginning of the second wave of the cycle. The mandate for conducting surveys of user’s experiences and satisfaction with services was first given in the white paper Modern Local Government: in Touch with the People (Department for the Environment, Trade and the Regions, 1998). In 2002 the Office of National Statistics (ONS) and SPRU developed a set of questionnaires for this purpose (Qureshi and Rowlands, 2004). Subsequent national surveys have drawn on this work to identify a set of compulsory questions for each round. User experience surveys (UESs) are regarded as an important part of the overall performance framework for social care and, providing councils with information about how they might improve services locally. Local authorities are required to submit their results to government bodies so that the relative performance of the CSSRs can be judged. This report is composed of five sections. The aims and objectives of the report are outlined in the second section and the method used to gather the data is outlined in section 3. In section 4 we report on the findings from the fieldwork and draw some conclusions and recommendations for the national survey in section 5. The topic guides for the focus groups and interviews are included in the appendices along with a brief discussion of the findings from the focus groups and a copy of the final extended questionnaire.

605 citations


Journal ArticleDOI
TL;DR: The addition of DBT to DM in the prevalent screening round was found to reduce the reader recall rate, with a modest associated increase in reader confidence.
Abstract: Aim To compare reader recall rate and confidence associated with recall decisions for digital mammography (DM) alone with DM plus digital breast tomosynthesis (DBT) in the prevalent screening round. Materials and methods Following regional ethics committee approval and written informed consent from all participating women, DM and DBT were obtained. DM followed by the combination of DM plus DBT were reviewed retrospectively by one of nine radiologists, for 880 women aged between 46 and 53. Differences in recall rates and reader confidence were assessed using the McNemar test and sign test, respectively. Subgroup analyses were performed for conventional prevalent round (aged 50–53 years) and age extension trial (aged 46–49 years) groups, as well as low breast density (BI-RADS A and B) and high breast density (BI-RADS C and D) groups. Results The recall rate using DM alone was 17.4% (95% confidence interval [CI] 15, 20). The recall rate using DM and DBT was 11.4% (95% CI: 9.5 to 13.8). There was a relative reduction of 35% (p=0.0001). There were reductions in both the conventional prevalent round (31.1% reduction, p=0.004) and age extension subgroups (37% reduction, p=0.0007). There were also reductions in both the low density group (37.2% reduction, p=0.0007) and the high density group (31.1% reduction, p=0.003). The median confidence rating with the recall decision was 7/10 using DM and 8/10 using the combination of DM and DBT (p=0.0001). Conclusion The addition of DBT to DM in the prevalent screening round was found to reduce the reader recall rate, with a modest associated increase in reader confidence.

7 citations


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TL;DR: The partnership with NMA is essential to building trust, dispelling misconceptions about clinical trials in the community, and to support a cadre of African American physicians and researchers who can contribute to the current understanding of the social determinants of breast cancer.
Abstract: To determine the best screening modality for breast cancer, a large randomized clinical trial is underway to compare the mammographic accuracy between the standard digital and tomosynthesis mammography. The Tomosynthesis Mammographic Imaging Screening Trial (TMIST) is also building the world's largest biorepository of breast cancer specimens from all biopsies at screening and wants to ensure it is representative of the US population. We invite the National Medical Association physicians, as leaders in the health care of African Americans, to continue their commitment to eliminating disparities by promoting the TMIST among African American women. The outcome of the trial will help to advance precision screening, individually tailoring screening decisions based on breast density, tumor subtyping and genomics. The partnership with NMA is essential to building trust, dispelling misconceptions about clinical trials in the community as well as to support a cadre of African American physicians and researchers who can contribute to the current understanding of the social determinants of breast cancer.

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Journal ArticleDOI
Abstract: Introduction Breast cancer (BC) screening using digital breast tomosynthesis (DBT) has been shown to increase cancer detection compared with mammography; however, it is unknown whether DBT impacts interval cancer rate (ICR). Methods We systematically identified prospective DBT studies reporting data on screen-detected and interval BCs to perform a study-level meta-analysis of the comparative effect of DBT on ICR in population screening. Meta-analysis of cancer detection rate (CDR), ICR, and the differences between DBT and mammography in CDR and ICR pooled estimates, included random-effects. Sensitivity analysis examined whether study methods (imaging used, comparison group design, interval BC ascertainment) affected pooled estimates. Results Five eligible prospective (non-randomised) studies of DBT population screening reported on 129,969 DBT-screened participants and 227,882 mammography-only screens, including follow-up publications reporting interval BC data. Pooled CDR was 9.03/1000 (95% confidence interval [CI] 8.53–9.56) for DBT, and 5.95/1000 (95% CI 5.65–6.28) for mammography: the pooled difference in CDR was 3.15/1000 (95% CI 2.53–3.77), and was evident for the detection of invasive and in-situ malignancy. Pooled ICR was 1.56/1000 DBT screens (95% CI 1.22–2.00), and 1.75/1000 mammography screens (95% CI 1.46–2.11): the estimated pooled difference in ICR was −0.15/1000 (95% CI –0.59 to 0.29) and was not substantially altered in several sensitivity analyses. Conclusions Meta-analysis shows consistent evidence that DBT significantly increased CDR compared with mammography screening; however, there was little difference between DBT and mammography in pooled ICR. This could suggest, but does not demonstrate, some over-detection. Meta-analysis using individual participant data, randomised trials and comparative studies quantifying cumulative detection and ICR over repeat DBT screen-rounds would provide valuable evidence to inform screening programs.

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References
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Journal ArticleDOI
Per Skaane1, Andriy I. Bandos2, Randi Gullien3, Ellen B. Eben3  +9 moreInstitutions (4)
TL;DR: The use of mammography plus tomosynthesis in a screening environment resulted in a significantly higher cancer detection rate and enabled the detection of more invasive cancers.
Abstract: We found a significant increase in cancer detection rates, particularly for invasive cancers, and a simultaneous decrease in false-positive rates with use of mammography plus tomosynthesis compared with mammography alone.

808 citations


Journal ArticleDOI
TL;DR: Integrated 2D and 3D mammography improves breast-cancer detection and has the potential to reduce false positive recalls.
Abstract: Summary Background Digital breast tomosynthesis with 3D images might overcome some of the limitations of conventional 2D mammography for detection of breast cancer. We investigated the effect of integrated 2D and 3D mammography in population breast-cancer screening. Methods Screening with Tomosynthesis OR standard Mammography (STORM) was a prospective comparative study. We recruited asymptomatic women aged 48 years or older who attended population-based breast-cancer screening through the Trento and Verona screening services (Italy) from August, 2011, to June, 2012. We did screen-reading in two sequential phases—2D only and integrated 2D and 3D mammography—yielding paired data for each screen. Standard double-reading by breast radiologists determined whether to recall the participant based on positive mammography at either screen read. Outcomes were measured from final assessment or excision histology. Primary outcome measures were the number of detected cancers, the number of detected cancers per 1000 screens, the number and proportion of false positive recalls, and incremental cancer detection attributable to integrated 2D and 3D mammography. We compared paired binary data with McNemar's test. Findings 7292 women were screened (median age 58 years [IQR 54–63]). We detected 59 breast cancers (including 52 invasive cancers) in 57 women. Both 2D and integrated 2D and 3D screening detected 39 cancers. We detected 20 cancers with integrated 2D and 3D only versus none with 2D screening only (p Interpretation Integrated 2D and 3D mammography improves breast-cancer detection and has the potential to reduce false positive recalls. Randomised controlled trials are needed to compare integrated 2D and 3D mammography with 2D mammography for breast cancer screening. Funding National Breast Cancer Foundation, Australia; National Health and Medical Research Council, Australia; Hologic, USA; Technologic, Italy.

642 citations


Journal ArticleDOI
25 Jun 2014-JAMA
TL;DR: Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate, and further studies are needed to assess the relationship to clinical outcomes.
Abstract: mammography + tomosynthesis; difference, 1.3 (95% CI, 0.4-2.1; P = .004); for cancer detection, 4.2 (95% CI, 3.8-4.7) with digital mammography vs 5.4 (95% CI, 4.9-6.0) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001); and for invasive cancer detection, 2.9 (95% CI, 2.5-3.2) with digital mammography vs 4.1 (95% CI, 3.7-4.5) with digital mammography + tomosynthesis; difference, 1.2 (95% CI, 0.8-1.6; P < .001). The in situ cancer detection rate was 1.4 (95% CI, 1.2-1.6) per 1000 screens with both methods. Adding tomosynthesis was associated with an increase in the positive predictive value for recall from 4.3% to 6.4% (difference, 2.1%; 95% CI, 1.7%-2.5%; P < .001) and for biopsy from 24.2% to 29.2% (difference, 5.0%; 95% CI, 3.0%-7.0%; P < .001). CONCLUSIONS AND RELEVANCE Addition of tomosynthesis to digital mammography was associated with a decrease in recall rate and an increase in cancer detection rate. Further studies are needed to assess the relationship to clinical outcomes.

611 citations


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  • ...Published studies of screening DBT have utilised various reading methods, including double reading by two radiologists [24], single reading with computedaided detection (CAD) [16,26] and, in a multicentre study of over 450,000 women, presumably either single reading or a mixture of methods [27]....

    [...]


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TL;DR: User experience surveys (UESs) are regarded as an important part of the overall performance framework for social care and, providing councils with information about how they might improve services locally, and are required to submit their results to government bodies so that the relative performance of the CSSRs can be judged.
Abstract: For some time now councils with social services responsibilities (CSSRs) have been required to conduct surveys of user’s experience of social services. These have taken place nationally in three-yearly cycles. In 2002/03 the survey was for older people, in 2003/04 it was for younger adults with physical and sensory impairments, and in 2004/05 it was for children. 2005/06 marked the beginning of the second wave of the cycle. The mandate for conducting surveys of user’s experiences and satisfaction with services was first given in the white paper Modern Local Government: in Touch with the People (Department for the Environment, Trade and the Regions, 1998). In 2002 the Office of National Statistics (ONS) and SPRU developed a set of questionnaires for this purpose (Qureshi and Rowlands, 2004). Subsequent national surveys have drawn on this work to identify a set of compulsory questions for each round. User experience surveys (UESs) are regarded as an important part of the overall performance framework for social care and, providing councils with information about how they might improve services locally. Local authorities are required to submit their results to government bodies so that the relative performance of the CSSRs can be judged. This report is composed of five sections. The aims and objectives of the report are outlined in the second section and the method used to gather the data is outlined in section 3. In section 4 we report on the findings from the fieldwork and draw some conclusions and recommendations for the national survey in section 5. The topic guides for the focus groups and interviews are included in the appendices along with a brief discussion of the findings from the focus groups and a copy of the final extended questionnaire.

605 citations


Journal ArticleDOI
Brian M. Haas1, Vivek B. Kalra, Jaime Geisel, Madhavi Raghu  +2 moreInstitutions (1)
TL;DR: Patients undergoing tomosynthesis plus digital mammography had significantly lower screening recall rates, and the greatest reductions were for those younger than 50 years and those with dense breasts.
Abstract: Although all breast density and age subgroups benefitted from the addition of tomosynthesis to conventional digital mammography, the patients receiving the greatest benefit were women with dense breasts and those younger than 50 years.

341 citations