{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:43:37Z","timestamp":1789825417615,"version":"4.0.1"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMW","doi-asserted-by":"publisher","award":["05550402130002"],"award-info":[{"award-number":["05550402130002"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004622","name":"KWF Kankerbestrijding","doi-asserted-by":"publisher","award":["2021\u201313710"],"award-info":[{"award-number":["2021\u201313710"]}],"id":[{"id":"10.13039\/501100004622","id-type":"DOI","asserted-by":"publisher"}]}],"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>It is uncertain what the effects of introducing digital breast tomosynthesis (DBT) in the Dutch breast cancer screening programme would be on detection, recall, and interval cancers (ICs), while reading times are expected to increase. Therefore, an investigation into the efficiency and cost-effectiveness of DBT screening while optimising reading is required.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and methods<\/jats:title>\n            <jats:p>The Screening Tomosynthesis trial with advanced REAding Methods (STREAM) aims to include 17,275 women (age 50\u201372\u2009years) eligible for breast cancer screening in the Netherlands for two biennial DBT screening rounds to determine the short-, medium-, and long-term effects and acceptability of DBT screening and identify an optimised strategy for reading DBT. The control group will consist of 86,400 women selected from the database of the Dutch breast cancer screening programme screened with digital mammography. The intervention group will undergo DBT examinations only. Four different reading strategies will be evaluated on a subset of first-round screening exams. These four strategies will also be evaluated combined with replacing one of the two readers with AI predictions. The Microsimulation Screening Analysis (MISCAN)-Breast model will be used to estimate the long-term outcomes of DBT screening assuming the best-performing reading method.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The primary outcome measure is the IC and advanced cancer rate at the second round (combined endpoint) in the DBT group compared to the control group. Secondary outcome measures are participation, recall and detection rates, positive predictive value, acceptability, reading method with the best case-based area under the curve and reading time, predicted breast cancer mortality, number of cancers overdiagnosed, and cost-effectiveness.<\/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> The short-, medium-, and long-term effects of digital breast tomosynthesis (DBT)\u00a0imaging in the Dutch breast cancer screening programme are unknown, but essential to decide about implementation.<\/jats:italic>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Findings<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic> This protocol paper describes the primary endpoint of the STREAM trial: the combined interval and advanced cancer detection rate at the second DBT round.<\/jats:italic>\n            <\/jats:p>\n            <jats:p>\n              <jats:bold>\n                <jats:italic>Clinical relevance<\/jats:italic>\n              <\/jats:bold>\n              <jats:italic> The STREAM trial is a prospective, non-randomised, population-based study in the Dutch breast cancer screening programme, that aims to evaluate the effects and acceptability of two rounds of DBT screening to determine if DBT can enhance the programme\u2019s outcomes.<\/jats:italic>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00330-024-11324-z","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T13:30:11Z","timestamp":1736429411000},"page":"3979-3986","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Screening Tomosynthesis Trial with Advanced Reader Methods (STREAM): design and rationale of a population-based breast cancer screening trial"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8262-0080","authenticated-orcid":false,"given":"Lindy","family":"Kregting","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daan","family":"van den Oever","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Pennings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruud","family":"Pijnappel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolien","family":"van Ravesteyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Verschuur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marja","family":"van Oirsouw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loes","family":"Dunning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"\u2018t Mannetje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"van Engen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Bluekens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maartje","family":"Smid-Geirnaerdt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary","family":"van Landsveld-Verhoeven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nehmat","family":"Houssami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Sechopoulos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireille","family":"Broeders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"key":"11324_CR1","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1093\/eurpub\/ckr170","volume":"22","author":"JM Timmers","year":"2012","unstructured":"Timmers JM, den Heeten GJ, Adang EM, Otten JD, Verbeek AL, Broeders MJ (2012) Dutch digital breast cancer screening: implications for breast cancer care. Eur J Public Health 22:925\u2013929","journal-title":"Eur J Public Health"},{"key":"11324_CR2","unstructured":"Integraal Kankercentrum Nederland (2020) Monitor Bevolkingsonderzoek Borstkanker 2018\/2019"},{"key":"11324_CR3","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1159\/000503715","volume":"14","author":"F Peintinger","year":"2019","unstructured":"Peintinger F (2019) National Breast Screening Programs across Europe. Breast Care 14:354\u2013358","journal-title":"Breast Care"},{"key":"11324_CR4","unstructured":"Erasmus MC (2023) Landelijke monitor bevolkingsonderzoek borstkanker 2022."},{"key":"11324_CR5","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1159\/000329005","volume":"6","author":"SH Heywang-K\u00f6brunner","year":"2011","unstructured":"Heywang-K\u00f6brunner SH, Hacker A, Sedlacek S (2011) Advantages and disadvantages of mammography screening. Breast Care 6:199\u2013207","journal-title":"Breast Care"},{"key":"11324_CR6","doi-asserted-by":"publisher","first-page":"2301","DOI":"10.1007\/s00330-021-08308-8","volume":"32","author":"SH Heywang-Kobrunner","year":"2022","unstructured":"Heywang-Kobrunner SH, Jansch A, Hacker A, Weinand S, Vogelmann T (2022) Digital breast tomosynthesis (DBT) plus synthesised two-dimensional mammography (s2D) in breast cancer screening is associated with higher cancer detection and lower recalls compared to digital mammography (DM) alone: results of a systematic review and meta-analysis. Eur Radiol 32:2301\u20132312","journal-title":"Eur Radiol"},{"key":"11324_CR7","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.ejca.2021.01.035","volume":"148","author":"N Houssami","year":"2021","unstructured":"Houssami N, Zackrisson S, Blazek K et al (2021) Meta-analysis of prospective studies evaluating breast cancer detection and interval cancer rates for digital breast tomosynthesis versus mammography population screening. Eur J Cancer 148:14\u201323","journal-title":"Eur J Cancer"},{"key":"11324_CR8","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":"11324_CR9","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1148\/radiol.2020192505","volume":"297","author":"VDV Sankatsing","year":"2020","unstructured":"Sankatsing VDV, Juraniec K, Grimm SE et al (2020) Cost-effectiveness of digital breast tomosynthesis in population-based breast cancer screening: a probabilistic sensitivity analysis. Radiology 297:40\u201348","journal-title":"Radiology"},{"key":"11324_CR10","doi-asserted-by":"publisher","first-page":"5437","DOI":"10.1007\/s00330-020-06812-x","volume":"30","author":"J Wang","year":"2020","unstructured":"Wang J, Phi XA, Greuter MJW et al (2020) The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program. Eur Radiol 30:5437\u20135445","journal-title":"Eur Radiol"},{"key":"11324_CR11","doi-asserted-by":"publisher","first-page":"1190","DOI":"10.1016\/j.healthpol.2018.08.004","volume":"122","author":"J Priaulx","year":"2018","unstructured":"Priaulx J, de Koning HJ, de Kok I, Szeles G, McKee M (2018) Identifying the barriers to effective breast, cervical and colorectal cancer screening in thirty one European countries using the Barriers to Effective Screening Tool (BEST). Health Policy 122:1190\u20131197","journal-title":"Health Policy"},{"key":"11324_CR12","doi-asserted-by":"publisher","unstructured":"Dustler M, Andersson M, F\u00f6rnvik D, Timberg P, Tingberg A (2013) A study of the feasibility of using slabbing to reduce tomosynthesis review time. In: Proceedings of SPIE Medical Imaging 8673. https:\/\/doi.org\/10.1117\/1112.2006987","DOI":"10.1117\/1112.2006987"},{"key":"11324_CR13","doi-asserted-by":"publisher","first-page":"e180096","DOI":"10.1148\/ryai.2019180096","volume":"1","author":"EF Conant","year":"2019","unstructured":"Conant EF, Toledano AY, Periaswamy S et al (2019) Improving accuracy and efficiency with concurrent use of artificial intelligence for digital breast tomosynthesis. Radiol Artif Intell 1:e180096","journal-title":"Radiol Artif Intell"},{"key":"11324_CR14","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1016\/S1470-2045(23)00298-X","volume":"24","author":"K L\u00e5ng","year":"2023","unstructured":"L\u00e5ng K, Josefsson V, Larsson A-M et al (2023) Artificial intelligence-supported screen reading versus standard double reading in the Mammography Screening with Artificial Intelligence trial (MASAI): a clinical safety analysis of a randomised, controlled, non-inferiority, single-blinded, screening acc. Lancet Oncol 24:936\u2013944","journal-title":"Lancet Oncol"},{"key":"11324_CR15","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1007\/s00330-012-2409-2","volume":"22","author":"JMH Timmers","year":"2012","unstructured":"Timmers JMH, Van Doorne-Nagtegaal HJ, Zonderland HM et al (2012) The Breast Imaging Reporting and Data System (BI-RADS) in the Dutch breast cancer screening programme: its role as an assessment and stratification tool. Eur Radiol 22:1717\u20131723","journal-title":"Eur Radiol"},{"key":"11324_CR16","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1038\/sj.bjc.6601912","volume":"91","author":"AJ Rijnsburger","year":"2004","unstructured":"Rijnsburger AJ, Essink-Bot ML, van Dooren S et al (2004) Impact of screening for breast cancer in high-risk women on health-related quality of life. Br J Cancer 91:69\u201376","journal-title":"Br J Cancer"},{"key":"11324_CR17","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1016\/S1470-2045(17)30438-2","volume":"18","author":"B O\u2019Sullivan","year":"2017","unstructured":"O\u2019Sullivan B, Brierley J, Byrd D et al (2017) The TNM classification of malignant tumours-towards common understanding and reasonable expectations. Lancet Oncol 18:849\u2013851","journal-title":"Lancet Oncol"},{"key":"11324_CR18","doi-asserted-by":"publisher","first-page":"357","DOI":"10.5694\/mja2.50320","volume":"211","author":"N Houssami","year":"2019","unstructured":"Houssami N, Lockie D, Clemson M et al (2019) Pilot trial of digital breast tomosynthesis (3D mammography) for population-based screening in BreastScreen Victoria. Med J Aust 211:357\u2013362","journal-title":"Med J Aust"},{"key":"11324_CR19","doi-asserted-by":"publisher","first-page":"2067","DOI":"10.1007\/s00330-010-1786-7","volume":"20","author":"AM Bluekens","year":"2010","unstructured":"Bluekens AM, Karssemeijer N, Beijerinck D et al (2010) Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates. Eur Radiol 20:2067\u20132073","journal-title":"Eur Radiol"},{"key":"11324_CR20","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1093\/rpd\/nch512","volume":"114","author":"DP Chakraborty","year":"2005","unstructured":"Chakraborty DP (2005) Recent advances in observer performance methodology: jackknife free-response ROC (JAFROC). Radiat Prot Dosimetry 114:26\u201331","journal-title":"Radiat Prot Dosimetry"},{"key":"11324_CR21","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1002\/ijc.29364","volume":"137","author":"R De Gelder","year":"2015","unstructured":"De Gelder R, Heijnsdijk EAM, Fracheboud J, Draisma G, De Koning HJ (2015) The effects of population\u2010based mammography screening starting between age 40 and 50 in the presence of adjuvant systemic therapy. Int J Cancer 137:165\u2013172","journal-title":"Int J Cancer"},{"key":"11324_CR22","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.ejca.2008.09.015","volume":"45","author":"R De Gelder","year":"2009","unstructured":"De Gelder R, Bulliard J-L, De Wolf C et al (2009) Cost-effectiveness of opportunistic versus organised mammography screening in Switzerland. Eur J Cancer 45:127\u2013138","journal-title":"Eur J Cancer"},{"key":"11324_CR23","doi-asserted-by":"publisher","first-page":"3059","DOI":"10.1002\/ijc.33126","volume":"147","author":"VDV Sankatsing","year":"2020","unstructured":"Sankatsing VDV, Van Ravesteyn NT, Heijnsdijk EAM, Broeders MJM, De Koning HJ (2020) Risk stratification in breast cancer screening: cost\u2010effectiveness and harm\u2010benefit ratios for low\u2010risk and high\u2010risk women. Int J Cancer 147:3059\u20133067","journal-title":"Int J Cancer"},{"key":"11324_CR24","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1002\/ijc.34000","volume":"151","author":"LM Kregting","year":"2022","unstructured":"Kregting LM, Sankatsing VDV, Heijnsdijk EAM, De Koning HJ, Van Ravesteyn NT (2022) Finding the optimal mammography screening strategy: a cost\u2010effectiveness analysis of 920 modelled strategies. Int J Cancer 151:287\u2013296","journal-title":"Int J Cancer"},{"key":"11324_CR25","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1093\/jnci\/djab119","volume":"113","author":"HA Geuzinge","year":"2021","unstructured":"Geuzinge HA, Bakker MF, Heijnsdijk EAM et al (2021) Cost-effectiveness of magnetic resonance imaging screening for women with extremely dense breast tissue. J Natl Cancer Inst 113:1476\u20131483","journal-title":"J Natl Cancer Inst"},{"key":"11324_CR26","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1016\/j.ypmed.2011.06.009","volume":"53","author":"R de Gelder","year":"2011","unstructured":"de Gelder R, Fracheboud J, Heijnsdijk EA et al (2011) Digital mammography screening: weighing reduced mortality against increased overdiagnosis. Prev Med 53:134\u2013140","journal-title":"Prev Med"},{"key":"11324_CR27","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1093\/epirev\/mxr009","volume":"33","author":"R de Gelder","year":"2011","unstructured":"de Gelder R, Heijnsdijk EA, van Ravesteyn NT, Fracheboud J, Draisma G, de Koning HJ (2011) Interpreting overdiagnosis estimates in population-based mammography screening. Epidemiol Rev 33:111\u2013121","journal-title":"Epidemiol Rev"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-024-11324-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-024-11324-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-024-11324-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T15:42:01Z","timestamp":1749829321000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-024-11324-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,9]]},"references-count":27,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["11324"],"URL":"https:\/\/doi.org\/10.1007\/s00330-024-11324-z","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,9]]},"assertion":[{"value":"30 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 August 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 November 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 2025","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 Mireille Broeders.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare relationships with the following companies: Mireille Broeders: Research\/grant support: Screenpoint Medical, Sectra Benelux, Hologic, Volpara Solutions, Lunit Inc., iCAD. Speaker: Hologic, Siemens Healthcare. Ioannis Sechopoulos: Research\/grants support: Siemens Healthcare, Canon Medical, Screenpoint Medical, Sectra Benelux, Hologic, Volpara Solutions, Lunit Inc, iCAD, E-COM. Speaker: Siemens Healthcare, Canon Medical. Advisory Board: Koning Corp. Nicolien van Ravesteyn: fees for consulting from Wickenstones (paid to institution). The remaining authors declare no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors (Mireille Broeders) has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects in the intervention arm in this study. Written informed consent was not required for the control arm because, in the Netherlands, informed consent is implied for the use of pseudonymised or aggregated cancer screening data when one takes up the offer of screening unless the individual specifically opts out. Individuals who withdrew consent, will not be included in the control arm.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The Minister of Health, Welfare and Sport has granted ethical approval and a license to conduct this trial from 1 May 2023 to 1 June 2028 (Registration number: 3574709-1044141-PG). This is considered equivalent to approval by an institutional review board.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}