Marinovich ML, et al. - Researchers assessed tomosynthesis vs 2D mammography with respect to breast cancer screening detection and recall in asymptomatic women. They found that tomosynthesis improved cancer detection rate (CDR) and attenuated recall. However, screening setting decided the effects ie, greater improvement was evident in CDR in European/Scandinavian studies (biennial screening) and reduction in recall in US studies with high baseline recall.

Methods

• For a systematic review and random effects meta-analysis, researchers searched electronic databases (2009–July 2017) to identify studies comparing tomosynthesis to 2D mammography in asymptomatic women who attended population breast cancer screening and reporting cancer detection rate (CDR) and recall rate.
• All statistical tests were two-sided.

Results

• They analyzed 17 studies (1,009,790 participants) from 413 citations.
• According to data, 1.6 cancers per 1,000 screens was the pooled incremental CDR for tomosynthesis (95% confidence interval [CI] = 1.1 to 2.0, P<.001, I² = 36.9%).
• Statistically significantly higher incremental CDR was reported for European/Scandinavian studies, all using a “paired” design where women had both tests (2.4 per 1000 screens, 95% CI = 1.9 to 2.9, P<.001, I² = 0.0%) vs US (“unpaired”) studies (1.1 per 1000 screens, 95% CI = 0.8 to 1.5, P<.001, I² = 0.0%; P<.001 between strata).
• For tomosynthesis vs 2D mammography, a statistically significantly lower recall rate was reported (pooled absolute reduction = –2.2%, 95% CI = –3.0 to –1.4, P<.001, I² = 98.2%).
• A decrease in US studies (pooled difference in recall rate = –2.9%, 95% CI=–3.5 to –2.4, P < .001, I²=92.9%) but not European/Scandinavian studies (0.5% increase in recall, 95% CI=–0.1 to 1.2, P=.12, I²=93.5%; P < .001 between strata) was evident in stratified analyses.
• They found similar results in sensitivity analyses, excluding studies with overlapping cohorts.