Screening Mammography Performance Metrics of 2D Digital Mammography Versus Digital Breast Tomosynthesis in Women With a Personal History of Breast Cancer

Background: Patients with a prior history of breast cancer are at higher risk for subsequent breast cancers and need close clinical and imaging follow-up. Limited data are available for screening these patients with digital breast tomosynthesis (DBT) versus full-field digital mammography (FFDM). Objective: To evaluate screening mammography performance of DBT vs FFDM in patients with prior history of breast cancer at a large academic oncology center. Methods: This retrospective study included consecutive patients with personal history of breast cancer treated with mastectomy or lumpectomy who underwent screening FFDM from October 2014-September 2016 (5706 examinations in 4091 patients) or screening DBT from February 2017-December 2018 (4440 examinations in 3647 patients). An institutional mammographic database was queried to obtain imaging type, breast density, history of mastectomy vs lumpectomy, and BI-RADS category. An institutional breast cancer registry identified cancer diagnoses. Screening performance metrics were compared between FFDM and DBT cohorts. Results: RR was significantly decreased with DBT vs. FFDM (7.9% vs. 10.1%; p 0.05). RRs were decreased with DBT vs. FFDM in both mastectomy (7.8% vs. 9.1%; p=0.09) and lumpectomy patients (7.9% vs. 11.0%; p=0.002) . PPV1 and CDR were not different between DBT and FFDM in mastectomy or lumpectomy patients (p>0.05). Conclusion: In patients with a personal history of breast cancer and non-dense breasts, DBT reduces RR and improves sensitivity and specificity, compared to FFDM. CDR and PPV1 are unchanged. Clinical Impact: In women with a personal history of breast cancer and non-dense breasts, DBT offers the potential to maintain the benefits of early cancer detection while reducing the potential harms of false positive examinations.