Women's attitudes and perspectives on the use of artificial intelligence in the assessment of screening mammograms.

PURPOSE: To investigate attitudes and perspectives on the use of artificial intelligence (AI) in the assessment of screening mammograms among women invited to BreastScreen Norway. METHOD: An anonymous survey was sent to all women invited to BreastScreen Norway during the study period, October 10, 2022, to December 25, 2022 (n = 84,543). Questions were answered on a 10-point Likert scale and as multiple-choice, addressing knowledge of AI, willingness to participate in AI studies, information needs, confidence in AI results and AI assisted reading strategies, and thoughts on concerns and benefits of AI in mammography screening. Analyses were performed using χ2 and logistic regression tests. RESULTS: General knowledge of AI was reported as extensive by 11.0% of the 8,355 respondents. Respondents were willing to participate in studies using AI either for decision support (64.0%) or triaging (54.9%). Being informed about use of AI-assisted image assessment was considered important, and a reading strategy of AI in combination with one radiologist preferred. Having extensive knowledge of AI was associated with willingness to participate in AI studies (decision support; odds ratio [OR]: 5.1, 95% confidence interval [CI]: 4.1-6.4, and triaging; OR: 3.4, 95% CI: 2.8-4.0) and trust in AI's independent assessment (OR: 6.8, 95% CI: 5.7, 8.3). CONCLUSIONS: Women invited to BreastScreen Norway had a positive attitude towards the use of AI in image assessment, given that human readers are still involved. Targeted information and increased public knowledge of AI could help achieve high participation in AI studies and successful implementation of AI in mammography screening.

Early screening outcomes before, during, and after a randomized controlled trial with digital breast tomosynthesis.

PURPOSE: To describe and compare early screening outcomes before, during and after a randomized controlled trial with digital breast tomosynthesis (DBT) including synthetic 2D mammography versus standard digital mammography (DM) (To-Be 1) and a follow-up cohort study using DBT (To-Be 2). METHODS: Retrospective results of 125,020 screening examinations from four consecutive screening rounds performed in 2014-2021 were described and compared for pre-To-Be 1 (DM), To-Be 1 (DM or DBT), To-Be 2 (DBT), and post-To-Be 2 (DM) cohorts. Descriptive analyses of rates of recall, biopsy, screen-detected and interval cancer, distribution of histopathologic tumor characteristics and time spent on image interpretation and consensus were presented for the four rounds including five cohorts, one cohort in each screening round except for the To-Be 1 trail, which included a DBT and a DM cohort. Odds ratios (OR) with 95% CIs was calculated for recall and cancer detection rates. RESULTS: Rate of screen-detected cancer was 0.90% for women screened with DBT in To-Be 2 and 0.64% for DM in pre-To-Be 1. The rates did not differ for the To-Be 1 DM (0.61%), To-Be 1 DBT (0.66%) and post-To-Be 2 DM (0.67%) cohorts. The interval cancer rates ranged between 0.13% and 0.20%. The distribution of histopathologic tumor characteristics did not differ between the cohorts. CONCLUSIONS: Screening all women with DBT following a randomized controlled trial in an organized, population-based screening program showed a temporary increase in the rate of screen-detected cancer.

Self-reported Pain Associated With Screening With Digital Breast Tomosynthesis.

OBJECTIVE: We aimed to investigate self-reported pain during screening with digital breast tomosynthesis (DBT). METHODS: The study was approved by the Regional Committee for Medical and Health Research Ethics in the South East of Norway (2015/424). Women completed a questionnaire about experienced pain directly after the examination, August-November 2019. A numeric rating scale (NRS, 0-10) was used. Data on compression force (N), pressure (kPa), and compressed breast thickness (mm) were obtained from the Digital Imaging and Communication in Medicine header and density assessment software. Stepwise ordinary least-squares regression was used to estimate mean self-reported pain score with 95% confidence interval (CI) for values of compression force, pressure, and compressed breast thickness. RESULTS: The mean pain score was 1.9, whereof 19.3% (822/4266) of the women reported moderate or severe pain. The mean pain score of 2.6 (95% CI: 2.4-2.7) was observed at a compression force of 60 N, decreasing to 1.3 (95% CI: 1.2-1.4) at 130 N. The mean pain score of 1.3 (95% CI: 1.1-1.4) was at a compression pressure of 6 kPa, increasing to 2.9 (95% CI: 2.7-3.1) at 16 kPa. The mean pain score was 0.6 (95% CI: 0.4-0.6) at a compressed breast thickness of 20 mm, increasing to 2.9 (95% CI: 2.7-3.1) at 90 mm. CONCLUSION: The mean pain score was low, 1.9 on NRS, for women screened with DBT. A compression force of 60-130 N and a pressure 6-16 kPa were associated with no or mild pain.

Cost differences between digital tomosynthesis and standard digital mammography in a breast cancer screening programme: results from the To-Be trial in Norway.

BACKGROUND: Several studies in Europe and the US have shown promising results favouring digital breast tomosynthesis compared to standard digital mammography (DM). However, the costs of implementing the technology in screening programmes are not yet known. METHODS: A randomised controlled trial comparing the results from digital breast tomosynthesis including synthetic mammograms (DBT) vs. DM was performed in Bergen during 2016 and 2017 as a part of BreastScreen Norway. The trial included 29,453 women and allowed for a detailed comparison of procedure use and screening, recall and treatment costs estimated at the individual level. RESULTS: The increased cost of equipment, examination and reading time with DBT vs. DM was €8.5 per screened woman (95% CI 8.4-8.6). Costs of DBT remained significantly higher after adding recall assessment costs, €6.2 (95% CI 4.6-7.9). Substantial reductions in either examination and reading times, price of DBT equipment or price of IT storage and connectivity did not change the conclusion. Adding treatment costs resulted in too wide confidence intervals to draw definitive conclusions (additional costs of tomosynthesis €9.8, 95% CI -56 to 74). Performing biopsy at recall, radiation therapy and chemotherapy was significantly more frequent among women screened with DBT. CONCLUSION: The results showed lower incremental costs of DBT vs. DM, compared to what is found in previous cost analyses of DBT and DM. However, the incremental costs were still higher for DBT compared with DM after including recall costs. Further studies with long-term treatment data are needed to understand the complete costs of implementing DBT in screening.