Abstract PO5-18-01: Cancer Detection Rate Meta-Analysis Comparison of Contemporary Dense-Breast Supplemental Screening Modalities
Authors: Tornai Martin , Hugg James , Patt Bradley , Chen Chin-Tu , Santos Eduardo , Erkanli Alaattin , Morrison Samantha , Covington Matthew 
Published: May 2024

Abstract
We performed a meta-analysis of the cancer detection rates from 24 published reports in dense breasts for all contemporary and FDA-approved imaging modalities (DM, DBT, U/S, CEM, MBI, MRI) available for supplemental breast cancer screening. This information is critical to the 40% of women with BIRADS categorized dense breasts (C,D) receiving breast cancer screening. In the paper an analysis of the net lives saved using a benefit-to-risk comparison of the ionizing imaging modalities (DM, DBT and MBI) is also presented and the safety of each technique is described. Note that it is well accepted that carcinogenic risk associated with ionizing radiation doses of &lt; 100 mSv are considered too small to be detected or altogether non-existant. Recently, with FDA's federal MQSA requirements changing to mandate notification of womens' dense-breast status (C,D), awareness has grown substantially about the dismal cancer detection performances of DM, DBT and U/S which degrades substantially with increasing breast density. Additionally, this May 2023, federal legislation was introduced in congress. The Find It Early Act (HR3086), should it become law in 2024, will require that healthcare payors cover costs for supplemental screening of women with dense breasts. Knowing and understanding the arsenal of the highest performing imaging modalities (based on cancer detection rates (CDR), Sensitivity, Specificity, NPV) is critically important for all patients and physicians caring for them. The volume of women qualifying for supplemental breast screening is expected to be managed by existing and growing numbers of all the best performing available technologies and approaches. Since the analysis is based on numerous others’ clinical trials of CDRs evaluating the various modalities in millions of women, this comprehensive analysis presents a level playing field for comparison. The top-three high performing imaging modalities (CEM, MBI, MRI) should be used to increase the number of early-stage cancers found in order to substantially decrease mortality, decrease patient trauma, decrease procedures, and decrease costs per cancer detected, all at overall benefit to the patients, the hospitals, the payors and provide long-term benefits to society.
Table. Summary of Relative Cancer Detection Rates (per 1,000 women) in Dense-Breast Supplemental Screening Results of multiple pairwise meta-analyses comparing various modalities (Digital Breast Tomosynthesis; Ultrasound; Contrast Enhanced Mammography; Molecular Breast Imaging; Magnetic Resonance Imaging) to Digital Mammography. “X” represents the second supplemental screening modality compared to DM. “+X” means the combination of DM+X. Two normalizations are compared: “CDR Ratio model” and “Incremental CDR model.”
Table. Net Lives Saved by Ionizing Radiation Imaging Modalities per Age Decade
Citation Format: Martin Tornai, James Hugg, Bradley Patt, Chin-Tu Chen, Eduardo Santos, Alaattin Erkanli, Samantha Morrison, Matthew Covington. Cancer Detection Rate Meta-Analysis Comparison of Contemporary Dense-Breast Supplemental Screening Modalities [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-18-01.