Recommendation for NHSScotland

For asymptomatic women attending routine breast screening, digital breast tomosynthesis (DBT) plus full-field digital mammography (FFDM) is better at detecting invasive cancer compared with FFDM alone. However, when DBT is used in addition to FFDM, this results in a double radiation dose.

Furthermore, the cost effectiveness of DBT is unclear; the existing evidence does not evaluate the potential impact of DBT on longer-term outcomes such as interval cancer rates and breast cancer mortality, and the impact on false positives and recall rates is not clear.

On balance, DBT should not currently be used in the screening population, although a large UK-based study of clinical and cost effectiveness is currently underway (PROSPECTS) and the results should be published around 2020.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.

What were we asked to look at?

In asymptomatic women attending for breast screening, what is the clinical and cost effectiveness of digital breast tomosynthesis (DBT) in addition to full-field digital mammography or synthetic 2D (FFDM or S2D) images, compared to FFDM alone?

Why is this important?

Over the last decade, most screening programmes have changed from 2D analogue mammography to full-field digital mammography (FFDM). This represents the current standard for most mammography programmes. This advice relates to the addition of digital breast tomosynthesis (DBT) to FFDM (or synthetic 2D, S2D) in routine breast screening. DBT is an advanced form of breast imaging. 

Referred by

SBSP (Scottish Breast Screening Programme) Clinical Directors Group