Tomosynthesis Versus Digital Mammography in a Population-based Screening Program

NCT ID: NCT02590315

Last Updated: 2019-01-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

92000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-12-31

Study Completion Date

2021-12-31

Brief Summary

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Preliminary results from prospective screening trials show that Digital Breast Tomosynthesis (DBT) is more sensitive and more specific than conventional digital mammography (DM). However, large randomised controlled trials (RCTs) are needed to confirm these promising results. Furthermore, potential side effects of DBT in the screening setting have to be properly evaluated. In particular, the major concern is about overdiagnosis and its consequences; overdiagnosis refers to the detection of cancers at screening, which would not have become clinically apparent in the woman's lifetime.

This RCT was designed to compare benefits and harms of DBT in a population-based screening program with conventional DM. The primary outcome parameter will be the difference between the two tests in rates of advanced cancers detected at the subsequent round and interval cancers (within the first two years after the study screening round). Secondary outcomes measures will be diagnostic performance indicators for organised breast screening (i.e, cancer detection rate, recall rate, false positive rate, positive predictive value), parameters used in cost-effectiveness analysis, pathologic and biological characteristics of screen-detected cancers.

Detailed Description

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Design of the study This trial will involve several hospital centres within the organised breast screening in the Italian region of Piedmont.

An invitation letter to participate in a randomised screening trial comparing DBT versus DM will be mailed to all women, 46-68 years old, living in the Piedmont Region, and eligible for invitation to the regional mammography screening program. Women who attend the centres for screening and consent to the study will be randomly allocated either to DBT or DM arm.

Women in the DM arm will be screened with bilateral, two-views digital mammography examination. Women in the DBT arm will be screened with the bilateral two-views combo mode (DM and DBT images acquired in a single compression). In both screening arms, examinations will be independently read by two expert screening radiologists. In the DBT arm, each reading will be randomly allocated (on a per-case basis) to one of these three modes: DM plus DBT (DBT is read only after initial DM interpretation), DBT plus DM (DM is read only after DBT interpretation) and "concurrent mode" (both DBT and DM are read simultaneously).

In both screening arms, participants will be recalled for further examination if indicated by at least one radiologist (without consensus or arbitration). At the subsequent round all participants will be invited to DM only. Interval cancers and advanced cancers screen-detected at the next round will be recorded. Pathological and biological parameters of screen-detected cancers (e.g, stage, grading, hormone receptors, HER2) in both screening arms will be measured to investigate overdiagnosis.

With a sample size of 23,000 and 69,000 women in the DBT and DM arm respectively, the investigators will be able to observe a significant decrease in interval cancers and advanced cancers rate of at least 50% (power 80%, two tails). The collected data will be also used to perform analyses on radiological work-flow and workload, and cost-outcome and cost-effectiveness.

Conditions

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Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

SINGLE

Participants

Study Groups

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Digital Breast Tomosynthesis - DBT

Invitation for breast screening and random allocation. Participants randomised to DBT will be screened with bilateral, two-view combo mode (DBT images are obtained with DM images). DBT participants will have an additional radiation exposure for the combined DM and DBT examinations.

Group Type EXPERIMENTAL

Invitation for breast screening and random allocation

Intervention Type OTHER

Invitation for breast screening; Women who consent to take part in the trial will be randomised to DBT or DM.

DBT

Intervention Type DEVICE

Combo-mode DBT. DBT participants will have an additional radiation exposure for breast tomosynthesis.

Conventional digital mammography - DM

Invitation for breast screening and random allocation. Participants randomised to DM will be screened with bilateral, two-view DM.

Group Type ACTIVE_COMPARATOR

Invitation for breast screening and random allocation

Intervention Type OTHER

Invitation for breast screening; Women who consent to take part in the trial will be randomised to DBT or DM.

Conventional digital mammography.

Intervention Type DEVICE

Conventional digital mammography.

Interventions

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Invitation for breast screening and random allocation

Invitation for breast screening; Women who consent to take part in the trial will be randomised to DBT or DM.

Intervention Type OTHER

DBT

Combo-mode DBT. DBT participants will have an additional radiation exposure for breast tomosynthesis.

Intervention Type DEVICE

Conventional digital mammography.

Conventional digital mammography.

Intervention Type DEVICE

Other Intervention Names

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Invitation Combo-mode DBT 3D mammography DM

Eligibility Criteria

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Inclusion Criteria

* Asymptomatic women 45-68 years, residents in the Piedmont Region, attending the regional breast cancer screening program

Exclusion Criteria

* Personal history of breast cancer
* A terminal illness
* Patients who are unable to give informed consent
* Breast implants
Minimum Eligible Age

46 Years

Maximum Eligible Age

68 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Regione Piemonte

OTHER

Sponsor Role collaborator

im3D S.p.A.

OTHER

Sponsor Role collaborator

Centro di Riferimento per l'Epidemiologia e la Prev. Oncologica Piemonte

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Alfonso Frigerio, Dr

Role: PRINCIPAL_INVESTIGATOR

SCDO Epidemiologia dei Tumori, AOU Città della Salute e della Scienza di Torino

Locations

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Senologia Di Screening - Sscvd

Turin, Piedmont, Italy

Site Status

Countries

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Italy

Other Identifiers

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CPO-PROTEUSDONNA

Identifier Type: -

Identifier Source: org_study_id

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