Research table: Digital breast tomosynthesis (3D mammography) for breast cancer screening

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Today, mammography is done using digital breast tomosynthesis (DBT). DBT is also called “tomo” or 3-dimensional (3D) mammography. It takes multiple 2-dimensional (2D) digital images of the breast, and computer software combines the 2D images to create a 3D image.

Studies show DBT may find a few more breast cancers than 2D digital mammography [1-5].

Learn more about mammography.

Learn about breast cancer screening recommendations for women at average risk.

Study measures (sensitivity and specificity)

The main goal of any cancer screening test is to correctly identify everyone who has cancer. This is called the sensitivity of the test. For example, a sensitivity of 90% means 90% of people tested who truly have cancer are correctly identified as having cancer.

An ideal cancer screening test would also be able to correctly identify all the people who don’t have cancer as not having it. This is called the specificity of the test. For example, a specificity of 90% means 90% of the people who don’t have cancer are correctly identified as not having cancer.

When sensitivity is high, the test picks up even the slightest abnormal finding. Very few cases are missed, but the test will mistake some people as having cancer when they don’t. This is called a false positive result.

When specificity is high, there are few false positive results, but more cases of true cancer are missed.

No screening test has perfect sensitivity and perfect specificity. There’s always a trade-off between the two. That is, when a test gains sensitivity, it loses some specificity.

Learn more about the quality of screening tests.

Study selection criteria: Clinical trials with at least 100 cases of invasive breast cancer cases.

Table note: The study findings below compare sensitivity and specificity for screening with 2D digital mammography plus DBT vs. screening with 2D digital mammography alone.

There are no data comparing survival among women who had 2D digital mammography versus those who had DBT (alone or in combination with 2D digital mammography).

Study	Study Population (number of participants)	Sensitivity		Specificity
		2D Digital Mammography Alone	2D Digital Mammography Plus DBT	2D Digital Mammography Alone	2D Digital Mammography Plus DBT
Clinical trials
Oslo Tomosynthesis Screening Trial [6]	24,301 (302 invasive breast cancer cases)*	76%	81%NS	96%	98%Sig

 

NS = No statistically significant difference between the 2 groups

Sig = Statistically significant difference between the 2 groups

* Included an additional 76 cases of ductal carcinoma in situ (DCIS)

References

1. Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 311(24):2499-2507, 2014.
2. Bernardi D, Macaskill P, Pellegrini M, et al. Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study. Lancet Oncol. 17(8):1105-13, 2016.
3. Siu AL on behalf of the U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 164(4):279-96, 2016.
4. Skaane P, Sebuødegård S, Bandos AI, et al. Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial. Breast Cancer Res Treat. 169(3):489-496, 2018.
5. Heindel W, Weigel S, Gerß J, et al. for the TOSYMA Screening Trial Study Group. Digital breast tomosynthesis plus synthesised mammography versus digital screening mammography for the detection of invasive breast cancer (TOSYMA): a multicentre, open-label, randomised, controlled, superiority trial. Lancet Oncol. 23(5):601-611, 2022.
6. Libesman S, Zackrisson S, Hofvind S, et al. An individual participant data meta-analysis of breast cancer detection and recall rates for digital breast tomosynthesis versus digital mammography population screening. Clin Breast Cancer. 22(5):e647-e654, 2022.

Updated 11/20/24