To prospectively identify which women would benefit the most from digital breast tomosynthesis, as first line breast cancer screening

Abstract

Purpose: The use of Digital Breast Tomosynthesis (DBT) as part of further assessment clinics in the local national breast cancer screening was introduced in 2015. The purpose of this study was to identify the different patient characteristics of patients being referred for further assessment clinics using DBT, at the national screening centre in Malta. This was done with the aim of understanding who would benefit from having a DBT as a first line screening modality. Objectives: The objectives of phase 1 were to audit and analyse the referrals for further assessment clinics within the local screening centre. In phase 2, data on the reason of referral together with the different patient characteristics, and the imaging results was collated to be able to reach the set objectives. Methodology: The study involved two sequential phases. Phase 1 of the study comprised of a retrospective analysis of statistical figures on the use and type of referrals for DBT within the local scenario. Phase 2 of the research was a prospective study composed of a self-designed patient questionnaire, required to evaluate any correlation between the different patient characteristics and the clinical outcome following a DBT. Results: For phase 1 of the study, 2,756 cases were included of which 35.9% had their first mammogram while 64.1% had a second/subsequent mammogram. First time mammogram cases were statistically the most prone to be returned back to normal screening (P<0.0005). In both phases, asymmetric densities was the most common reason of referral (61.1% in phase 1 and 50.9% in phase 2). For phase 2, 53 participants were recruited. Results indicated that the most common types of Mammographic Breast Densities were type BIRADS - A (30.2 %) and BIRADS – B (50.9%). Conclusion: From the results collected in both phases it was shown that women screened for the first-time would benefit from DBT as a first line screening tool since they are more likely to be returned back to normal screening.