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Digital mammography and digital breast tomosynthesis for detecting invasive lobular and ductal carcinoma

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Invasive lobular carcinoma (ILC) is a distinct histological subtype of breast cancer that can make early detection with mammography challenging. We compared imaging performance of digital breast tomosynthesis (DBT) to digital mammography (DM) for diagnoses of ILC, invasive ductal carcinoma (IDC), and invasive mixed carcinoma (IMC) in a screening population.

Methods

We included screening exams (DM; n = 1,715,249 or DBT; n = 414,793) from 2011 to 2018 among 839,801 women in the Breast Cancer Surveillance Consortium. Examinations were followed for one year to ascertain incident ILC, IDC, or IMC. We measured cancer detection rate (CDR) and interval invasive cancer rate/1000 screening examinations for each histological subtype and stratified by breast density and modality. We calculated relative risk (RR) for DM vs. DBT using log-binomial models to adjust for the propensity of receiving DBT vs. DM.

Results

Unadjusted CDR per 1000 mammograms of ILC overall was 0.33 (95%CI: 0.30–0.36) for DM; 0.45 (95%CI: 0.39–0.52) for DBT, and for women with dense breasts- 0.33 (95%CI: 0.29–0.37) for DM and 0.54 (95%CI: 0.43–0.66) for DBT. Similar results were noted for IDC and IMC. Adjusted models showed a significantly increased RR for cancer detection with DBT compared to DM among women with dense breasts for all three histologies (RR; 95%CI: ILC 1.53; 1.09–2.14, IDC 1.21; 1.02–1.44, IMC 1.76; 1.30–2.38), but no significant increase among women with non-dense breasts.

Conclusion

DBT was associated with higher CDR for ILC, IDC, and IMC for women with dense breasts. Early detection of ILC with DBT may improve outcomes for this distinct clinical entity.

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Data availability

Data:: BCSC (bcsc-research.org). Data collected and maintained by the Breast Cancer Surveillance Consortium are protected by a Federal Certificate of Confidentiality from the National Institutes of Health (NIH). Per the terms of this certificate, identifiable data shall be disclosed only when: required by federal, state, or local laws; necessary for medical treatment of the individual to whom the data pertains; made with the consent of the individual; or made for the purposes of other scientific research complying with federal regulations governing human subjects research. For more details on these protections and their limits, please visit the NIH Certificate of Confidentiality Website.

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Acknowledgements

The collection of cancer and vital status data used in this study was supported in part by several state public health departments and cancer registries throughout the U.S. For a full description of these sources, please see: https://www.bcsc-research.org/about/work-acknowledgement. All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee, nor those of the National Cancer Institute or the National Institutes of Health. We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study. You can learn more about the BCSC at: http://www.bcsc-research.org/.

The collection of cancer incidence and vital status data used in this study was supported, in part, by:

The California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Sect. 103,885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement U58-DP003862-01 awarded to the California Department of Public Health;

The Vermont Cancer Registry, supported in part by Cooperative Agreement NU58DP006322 from the Centers for Disease Control and Prevention, awarded to the Vermont State Agency of Human Services.

The Cancer Surveillance System of the Fred Hutchinson Cancer Research Center, which is funded by contracts N01-CN-005230, N01-CN-67009, N01-PC-35142, HHSN261201000029C, and HHSN261201300012I from the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute with additional support from the Fred Hutchinson Cancer Research Center and the State of Washington;

The New Hampshire State Cancer Registry supported in part by cooperative agreement U55/CCU-121912 awarded to the New Hampshire Department of Health and Human Services, Division of Public Health Services, Bureau of Disease Control and Health Statistics, Health Statistics and Data Management Section;

The North Carolina Central Cancer Registry, which is partially supported by the Centers for Disease Control and Prevention under cooperative agreement DP12-120503CONT14;

Manuscripts including data from the Metro Chicago Breast Cancer Registry were supported in part by the Illinois Department of Public Health, Illinois State Cancer Registry which is partially supported by the Centers for Disease Control and Prevention under cooperative agreement DP12-120504CONT15.

The ideas and opinions expressed herein are those of the authors and endorsement by the State of California, the California Department of Public Health; Illinois Department of Public Health; New Hampshire Department of Health and Human Services; the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

We thank the participating women, mammography facilities, and radiologists for the data they have provided for this study.

Funding

This work was supported by the Breast Cancer Surveillance Consortium with funding from the National Cancer Institute (P01CA154292, U54CA163303, R01CA149365, R50CA211115) and the Agency for Health Research and Quality (R01 HS018366-01A1). Data collection for this research was additionally funded through a Patient-Centered Outcomes Research Institute (PCORI) Program Award (PCS-1504–30370).

Author information

Authors and Affiliations

  1. Department of Population Health Sciences, and the Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Dr., RS 4725, Salt Lake City, UT, 84018, USA

    Tracy Onega

  2. Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA

    Linn Abraham, Diana L. Miglioretti & Erin J. Aiello Bowles

  3. Department of Public Health Sciences, University of California, Davis, CA, USA

    Diana L. Miglioretti

  4. Department of Radiology, University of Washington, and Fred Hutchinson Cancer Center, Seattle, WA, USA

    Christoph I. Lee

  5. Department of Radiology, University of North Carolina, Chapel Hill, NC, USA

    Louise M. Henderson

  6. Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Karla Kerlikowske

  7. General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA

    Karla Kerlikowske

  8. The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

    Anna N. A. Tosteson

  9. Department of Pathology, University of Vermont, Burlington, VT, USA

    Donald Weaver

  10. Departments of Surgery and Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, VT, USA

    Brian L. Sprague

  11. Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Roberta M. di Florio-Alexander

Authors
  1. Tracy Onega
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  2. Linn Abraham
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  4. Christoph I. Lee
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  11. Roberta M. di Florio-Alexander
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Contributions

Conceptualization: TO, DLM, CIL, RMD; Data curation: TO, LA, DLM, CIL, LMH, KK, DW, BLS, EJAB; Formal Analysis: LA, TO, DLM. Methodology: TO, LA, DLM, CIL, LMH, KK, DW, BLS, EJAB, RMD. Supervision: TO. Writing—original draft: TO. Writing—review & editing: TO, LA, DLM, CIL, LMH, KK, DW, BLS, EJAB, RMD. The National Cancer Institute had no role in the study’s design; the collection, analysis, or interpretation of the data; the writing of the manuscript; or the decision to submit the manuscript for publication. Likewise, the content in this manuscript is solely the responsibility of the authors and does not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee.

Corresponding author

Correspondence to Tracy Onega.

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Conflict of interest

C.I. Lee receives personal fees from the American College of Radiology for journal editorial board work and textbook royalties from UpToDate, Inc., Oxford University Press, and McGraw Hill, Inc. There are no other conflicts of interest to disclosure for any of the other authors.

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Onega, T., Abraham, L., Miglioretti, D.L. et al. Digital mammography and digital breast tomosynthesis for detecting invasive lobular and ductal carcinoma. Breast Cancer Res Treat 202, 505–514 (2023). https://doi.org/10.1007/s10549-023-07051-6

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