{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:03:03Z","timestamp":1791637383290,"version":"4.3.4"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T00:00:00Z","timestamp":1727913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/http:\/\/dx.doi.org\/10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1194410"],"award-info":[{"award-number":["1194410"]}],"id":[{"id":"10.13039\/http:\/\/dx.doi.org\/10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Medical Research Future Fund","award":["1199927"],"award-info":[{"award-number":["1199927"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to synthesise evidence from prospective studies of digital breast tomosynthesis (DBT) screening to assess its effectiveness compared to digital mammography (DM). Specifically, we examined whether DBT reduces interval cancer rates (ICRs) in population breast cancer screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We performed a systematic review and meta-analysis of DBT screening studies (identified from January 2013 to March 2024). We included both RCTs and non-randomised prospective studies that used an independent comparison for our primary outcome ICRs. The risk of bias was assessed with QUADAS-2. We compared the ICR, cancer detection rate (CDR), and recall rate of DBT and DM screening using random effects meta-analysis models. Subgroup analyses estimated outcomes by study design. Sensitivity analyses estimated absolute effects from relative effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten prospective studies (three RCTs, seven non-randomised) were eligible; all had a low risk of bias. There were 205,245 DBT-screened and 306,476 DM-screened participants with follow-up for interval cancer data. The pooled absolute ICR did not significantly differ between DBT and DM: \u22122.92 per 10,000 screens (95% CI: \u22126.39 to 0.54); however subsequent subgroup analysis indicated certain study designs may have biased this ICR estimate. Pooled ICR from studies that only sampled groups from the same time and region indicated DBT led to 5.50 less IC per 10,000 screens (95% CI: \u22129.47 to \u22121.54). Estimates from subgroup analysis that compared randomised and non-randomised trials did not significantly differ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This meta-analysis provides suggestive evidence that DBT decreases ICR relative to DM screening; further evidence is needed to reduce uncertainty regarding ICR differences between DBT and DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Does DBT have long-term benefits over standard DM<\/jats:italic>\n                      ?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Finding<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>We find suggestive evidence in our primary analysis and stronger evidence in a follow-up analysis that DBT reduces interval cancers<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>This meta-analysis provides the first indication that DBT may detect additional cancers that are clinically meaningful, based on suggestive evidence of a reduction in ICR. This finding does not preclude the simultaneous possibility of overdiagnosis<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-024-11085-9","type":"journal-article","created":{"date-parts":[[2024,10,3]],"date-time":"2024-10-03T12:03:40Z","timestamp":1727957020000},"page":"1478-1489","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Interval breast cancer rates for tomosynthesis vs mammography population screening: a systematic review and meta-analysis of prospective studies"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7513-2663","authenticated-orcid":false,"given":"Sol","family":"Libesman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Luke","family":"Marinovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Lene","family":"Seidler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto Stefano","family":"Tagliafico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nehmat","family":"Houssami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,3]]},"reference":[{"key":"11085_CR1","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1080\/14737140.2018.1483243","volume":"18","author":"T Li","year":"2018","unstructured":"Li T, Marinovich ML, Houssami N (2018) Digital breast tomosynthesis (3D mammography) for breast cancer screening and for assessment of screen-recalled findings: review of the evidence. Expert Rev Anticancer Ther 18:785\u2013791","journal-title":"Expert Rev Anticancer Ther"},{"key":"11085_CR2","doi-asserted-by":"publisher","first-page":"e647","DOI":"10.1016\/j.clbc.2022.02.005","volume":"22","author":"S Libesman","year":"2022","unstructured":"Libesman S, Zackrisson S, Hofvind S et al (2022) 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:e647\u2013e654","journal-title":"Clin Breast Cancer"},{"key":"11085_CR3","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/S1470-2045(13)70134-7","volume":"14","author":"S Ciatto","year":"2013","unstructured":"Ciatto S, Houssami N, Bernardi D et al (2013) Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 14:583\u2013589","journal-title":"Lancet Oncol"},{"key":"11085_CR4","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1093\/jnci\/djy121","volume":"110","author":"ML Marinovich","year":"2018","unstructured":"Marinovich ML, Hunter KE, Macaskill P, Houssami N (2018) Breast cancer screening using tomosynthesis or mammography: a meta-analysis of cancer detection and recall. J Natl Cancer Inst 110:942\u2013949","journal-title":"J Natl Cancer Inst"},{"key":"11085_CR5","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1007\/s00330-015-3803-3","volume":"26","author":"K L\u00e5ng","year":"2016","unstructured":"L\u00e5ng K, Andersson I, Rosso A, Tingberg A, Timberg P, Zackrisson S (2016) Performance of one-view breast tomosynthesis as a stand-alone breast cancer screening modality: results from the Malm\u00f6 breast tomosynthesis screening trial, a population-based study. Eur Radiol 26:184\u2013190","journal-title":"Eur Radiol"},{"key":"11085_CR6","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/S1470-2045(22)00215-7","volume":"23","author":"N Houssami","year":"2022","unstructured":"Houssami N (2022) Should tomosynthesis replace mammography for breast cancer screening? Lancet Oncol 23:554\u2013555","journal-title":"Lancet Oncol"},{"key":"11085_CR7","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1038\/bjc.2013.177","volume":"108","author":"MG Marmot","year":"2013","unstructured":"Marmot MG, Altman D, Cameron D, Dewar J, Thompson S, Wilcox M (2013) The benefits and harms of breast cancer screening: an independent review. Br J Cancer 108:2205\u20132240","journal-title":"Br J Cancer"},{"key":"11085_CR8","unstructured":"European Commission Initiative on Breast Cancer (ECIBC) (2023) European guidelines on breast cancer screening and diagnosis. 5. Use of Tomosynthesis. Available via https:\/\/cancer-screening-and-care.jrc.ec.europa.eu\/en\/ecibc\/european-breast-cancer-guidelines?topic=65&usertype=60&updatef2=0"},{"key":"11085_CR9","doi-asserted-by":"publisher","DOI":"10.1038\/s41523-017-0014-x","volume":"3","author":"N Houssami","year":"2017","unstructured":"Houssami N, Hunter K (2017) The epidemiology, radiology and biological characteristics of interval breast cancers in population mammography screening. NPJ Breast Cancer 3:12","journal-title":"NPJ Breast Cancer"},{"key":"11085_CR10","doi-asserted-by":"publisher","first-page":"14647","DOI":"10.3390\/ijerph192214647","volume":"19","author":"R Farber","year":"2022","unstructured":"Farber R, Houssami N, Barnes I, McGeechan K, Barratt A, Bell KJ (2022) Considerations for evaluating the introduction of new cancer screening technology: use of interval cancers to assess potential benefits and harms. Int J Environ Res Public Health 19:14647","journal-title":"Int J Environ Res Public Health"},{"key":"11085_CR11","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.100804","volume":"34","author":"N Houssami","year":"2021","unstructured":"Houssami N, Hofvind S, Soerensen AL et al (2021) Interval breast cancer rates for digital breast tomosynthesis versus digital mammography population screening: an individual participant data meta-analysis. EClinicalMedicine 34:100804","journal-title":"EClinicalMedicine"},{"key":"11085_CR12","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1136\/adc.2004.058222","volume":"90","author":"AK Akobeng","year":"2005","unstructured":"Akobeng AK (2005) Understanding randomised controlled trials. Arch Dis Child 90:840\u2013844","journal-title":"Arch Dis Child"},{"key":"11085_CR13","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1136\/bmj.292.6522.746","volume":"292","author":"MJ Gardner","year":"1986","unstructured":"Gardner MJ, Altman DG (1986) Confidence intervals rather than P values: estimation rather than hypothesis testing. Br Med J (Clin Res Ed) 292:746\u2013750","journal-title":"Br Med J (Clin Res Ed)"},{"key":"11085_CR14","doi-asserted-by":"crossref","unstructured":"Sch\u00fcnemann HJ, Higgins JP, Vist GE et al (2019) Completing \u2018Summary of findings\u2019 tables and grading the certainty of the evidence. In: Cochrane Handbook for systematic reviews of interventions. Wiley, Chichester, pp 375\u2013402","DOI":"10.1002\/9781119536604.ch14"},{"key":"11085_CR15","doi-asserted-by":"publisher","first-page":"e073141","DOI":"10.1136\/bmj-2022-073141","volume":"381","author":"MH Murad","year":"2023","unstructured":"Murad MH, Wang Z, Zhu Y, Saadi S, Chu H, Lin L (2023) Methods for deriving risk difference (absolute risk reduction) from a meta-analysis. BMJ 381:e073141","journal-title":"BMJ"},{"key":"11085_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v036.i03","volume":"36","author":"W Viechtbauer","year":"2010","unstructured":"Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Softw 36:1\u201348","journal-title":"J Stat Softw"},{"key":"11085_CR17","unstructured":"Team RC (2024) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. https:\/\/www.R-projectorg\/"},{"key":"11085_CR18","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1148\/radiol.2021203936","volume":"300","author":"S Hofvind","year":"2021","unstructured":"Hofvind S, Moshina N, Holen \u00c5S et al (2021) Interval and subsequent round breast cancer in a randomized controlled trial comparing digital breast tomosynthesis and digital mammography screening. Radiology 300:66\u201376","journal-title":"Radiology"},{"key":"11085_CR19","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20230081","volume":"96","author":"N Houssami","year":"2023","unstructured":"Houssami N, Lockie D, Giles M, Noguchi N, Marr G, Marinovich ML (2023) Two-year follow-up of participants in the BreastScreen Victoria pilot trial of tomosynthesis versus mammography: breast density-stratified screening outcomes. Br J Radiol 96:20230081","journal-title":"Br J Radiol"},{"key":"11085_CR20","doi-asserted-by":"crossref","unstructured":"Pulido-Carmona C, Romero-Mart\u00edn S, Raya-Povedano JL et al (2024) Interval cancer in the C\u00f3rdoba breast tomosynthesis screening trial (CBTST): comparison of digital breast tomosynthesis plus digital mammography to digital mammography alone. Eur Radiol 34:5427\u20135438","DOI":"10.1007\/s00330-023-10546-x"},{"key":"11085_CR21","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1148\/radiol.2021204106","volume":"299","author":"K Johnson","year":"2021","unstructured":"Johnson K, L\u00e5ng K, Ikeda DM, \u00c5kesson A, Andersson I, Zackrisson S (2021) Interval breast cancer rates and tumor characteristics in the prospective population-based Malm\u00f6 breast tomosynthesis screening trial. Radiology 299:559\u2013567","journal-title":"Radiology"},{"key":"11085_CR22","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s10549-018-4705-2","volume":"169","author":"P Skaane","year":"2018","unstructured":"Skaane P, Sebu\u00f8deg\u00e5rd S, Bandos AI et al (2018) Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo tomosynthesis screening trial. Breast Cancer Res Treat 169:489\u2013496","journal-title":"Breast Cancer Res Treat"},{"key":"11085_CR23","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1148\/radiol.2019191337","volume":"294","author":"T Hovda","year":"2020","unstructured":"Hovda T, Holen \u00c5S, L\u00e5ng K et al (2020) Interval and consecutive round breast cancer after digital breast tomosynthesis and synthetic 2D mammography versus standard 2D digital mammography in BreastScreen Norway. Radiology 294:256\u2013264","journal-title":"Radiology"},{"key":"11085_CR24","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1002\/ijc.34161","volume":"151","author":"P Armaroli","year":"2022","unstructured":"Armaroli P, Frigerio A, Correale L et al (2022) A randomised controlled trial of digital breast tomosynthesis vs digital mammography as primary screening tests: screening results over subsequent episodes of the Proteus Donna study. Int J Cancer 151:1778\u20131790","journal-title":"Int J Cancer"},{"key":"11085_CR25","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1148\/radiol.211132","volume":"303","author":"P Pattacini","year":"2022","unstructured":"Pattacini P, Nitrosi A, Giorgi Rossi P et al (2022) A randomized trial comparing breast cancer incidence and interval cancers after tomosynthesis plus mammography versus mammography alone. Radiology 303:256\u2013266","journal-title":"Radiology"},{"key":"11085_CR26","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.breast.2018.01.002","volume":"38","author":"N Houssami","year":"2018","unstructured":"Houssami N, Bernardi D, Caumo F et al (2018) Interval breast cancers in the \u2018screening with tomosynthesis or standard mammography\u2019 (STORM) population-based trial. Breast 38:150\u2013153","journal-title":"Breast"},{"key":"11085_CR27","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.breast.2019.09.012","volume":"50","author":"D Bernardi","year":"2020","unstructured":"Bernardi D, Gentilini MA, De Nisi M et al (2020) Effect of implementing digital breast tomosynthesis (DBT) instead of mammography on population screening outcomes including interval cancer rates: results of the Trento DBT pilot evaluation. Breast 50:135\u2013140","journal-title":"Breast"},{"key":"11085_CR28","doi-asserted-by":"publisher","first-page":"2058","DOI":"10.1007\/s00330-019-06549-2","volume":"30","author":"M Alabousi","year":"2020","unstructured":"Alabousi M, Zha N, Salameh J-P et al (2020) Digital breast tomosynthesis for breast cancer detection: a diagnostic test accuracy systematic review and meta-analysis. Eur Radiol 30:2058\u20132071","journal-title":"Eur Radiol"},{"key":"11085_CR29","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1177\/0969141316668379","volume":"24","author":"PA van Luijt","year":"2017","unstructured":"van Luijt PA, Heijnsdijk EA, van Ravesteyn NT, Hofvind S, de Koning HJ (2017) Breast cancer incidence trends in Norway and estimates of overdiagnosis. J Med Screen 24:83\u201391","journal-title":"J Med Screen"},{"key":"11085_CR30","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1159\/000503219","volume":"14","author":"U Dafni","year":"2019","unstructured":"Dafni U, Tsourti Z, Alatsathianos I (2019) Breast cancer statistics in the European Union: incidence and survival across European countries. Breast Care (Basel) 14:344\u2013353","journal-title":"Breast Care (Basel)"},{"key":"11085_CR31","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.ejca.2013.09.018","volume":"50","author":"J Nederend","year":"2014","unstructured":"Nederend J, Duijm LE, Louwman MW et al (2014) Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment\u2014a population-based study from the Netherlands. Eur J Cancer 50:31\u201339","journal-title":"Eur J Cancer"},{"key":"11085_CR32","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1038\/s41416-022-01790-x","volume":"127","author":"T Li","year":"2022","unstructured":"Li T, Houssami N, Noguchi N, Zeng A, Marinovich ML (2022) Differential detection by breast density for digital breast tomosynthesis versus digital mammography population screening: a systematic review and meta-analysis. Br J Cancer 127:116\u2013125","journal-title":"Br J Cancer"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-024-11085-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-024-11085-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-024-11085-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T13:37:16Z","timestamp":1739885836000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-024-11085-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,3]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["11085"],"URL":"https:\/\/doi.org\/10.1007\/s00330-024-11085-9","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,3]]},"assertion":[{"value":"24 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 June 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 August 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Sol Libesman.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors (Sol Libesman) has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was not required for this study because it is a review of published information. Written informed consent was obtained from all subjects (patients) in the studies included in the review.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Some study subjects or cohorts have been previously reported in: Houssami et al [\n                      \n                      ].","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}