Feasibility study comparing synthesized mammography with digital breast tomosynthesis and digital mammography for simulated first round screening in a single BreastScreen NSW centre.

INTRODUCTION: While digital breast tomosynthesis (DBT) has proven to enhance cancer detection and reduce recall rates (RR), its integration into BreastScreen Australia for screening has been limited, in part due to perceived cost implications. This study aims to assess the cost effectiveness of digital mammography (DM) compared with synthesized mammography and DBT (SM + DBT) in a first round screening context for short-term outcomes. METHODS: Clients recalled for nonspecific density (NSD) as a single lesion by both readers at the Northern Sydney Central Coast BreastScreen service in 2019 were included. Prior images were excluded to simulate first-round screening. Eleven radiologists read DM and synthesized mammography with DBT (SM + DBT) images 4 weeks apart. Recall rates (RR), reading time, and diagnostic parameters were measured, and costs for screen reading and assessment were calculated. RESULT: Among 65 clients studied, 13 were diagnosed with cancer, with concordant cancer recalls. SM + DBT reduced recall rates (RR), increased reading time, maintained cancer detection sensitivity, and significantly improved other diagnostic parameters, particularly false positive rates. Benign biopsy recalls remained equivalent. While SM + DBT screen reading cost was significantly higher than DM (DM AU$890 ± 186 vs SM + DBT AU$1279 ± 265; P < 0.001), the assessment cost (DM AU$29,504 ± 9427 vs SM + DBT AU$18,021 ± 5606; P < 0.001), and combined screen reading and assessment costs were significantly lower (DM AU$30,394 ± 9508 vs SM + DBT AU$19,300 ± 5721; P = 0.001). SM + DBT screen reading and assessment of 65 patients resulted in noteworthy cost savings (AU$11,094), equivalent to assessing 12 additional clients. CONCLUSION: In first round screening, DBT yields significant cost savings by effectively reducing unnecessary recalls to assessment while maintaining diagnostic efficacy.

A 4-year assessment of a new water-fluoridation scheme in New South Wales, Australia.

OBJECTIVE: To monitor the changes in dental caries prevalence of 5- to 7-year-old children living in a fluoridated area, a newly fluoridated area and in an area without water fluoridation, in NSW, Australia. METHODS: Dental caries prevalence was recorded for 5- to 7-year-old children, living in the three study locations, by six trained and calibrated examiners in 2008, 2010 and 2012. A questionnaire recorded demographic data, toothbrushing behaviour and sugary drink consumption. Caries experience was measured using the decayed, missing, and filled teeth (dmft) index for primary teeth, the percentage of children who were caries free and the significant caries index. Univariate analysis was undertaken to determine independent predictors of caries. RESULTS: The caries prevalence changed over time. In 2008, the mean dmft index was 1.40 for the fluoridated area, 2.02 for the area about to fluoridate and 2.09 for the unfluoridated control. By 2012, these mean dmft scores were 0.69, 0.72 and 1.21, respectively. In the two areas where children received fluoridated water, the significant caries index was 2.30 for the fluoridated area and 2.40 for the newly fluoridated area. The significant caries score for children in the unfluoridated location was 3.93. Multivariate analysis showed that over time the differences in dental caries prevalence between the established fluoride area and the newly fluoridated area diminished. However, children in the unfluoridated control area continued to demonstrate significant differences in the mean number of decayed teeth compared with children in the fluoridated comparator sites, and the proportions of children free from decay were significantly higher in the fluoridated areas than in the unfluoridated area. CONCLUSION: Fluoridation of public water supplies in Gosford and Wyong offers young children better dental health than those children who do not have access to this public health measure.

The Dental Health of primary school children living in fluoridated, pre-fluoridated and non-fluoridated communities in New South Wales, Australia.

BACKGROUND: The Local Government Area of Gosford implemented a water fluoridation scheme in 2008. Therefore the opportunity was taken to record the dental health of primary school children aged 5-7 years prior to the fluoridation and compare the results with other communities in NSW with different access to fluoridated water. The aim was to compare the oral health of New South Wales (Australia)s 5-7 year olds living in fluoridated, and non- fluoridated communities. One of the areas was due to implement water fluoridation and is termed the pre-fluoridation site. METHODS: Pupils in the first year of Public and Catholic Schools in three areas of NSW were recruited. Class lists were used to draw a sample of approximately 900 per area. This number allowed for a non-response rate of up to 30 per cent and would give a sample sufficient numbers to allow statistical inferences to be drawn. Children whose parents consented received a dental examination and the clinical data was collected on mark sense cards. RESULTS: In the 3 areas the proportion of children who received a dental examination varied; 77.5% (n = 825) for the fluoridated area, 80.1% (n = 781) for the pre-fluoridated area and 55.3% (n = 523) for the non-fluoridated area. The mean dmft was 1.40 for the fluoridated area, 2.02 for the pre-fluoridated area and 2.09 for the non-fluoridated area. These differences were statistically significant (p < 0.01). Differences were also noted in the proportion of children who were caries free, 62.6% fluoridated area, 50.8% for the pre-fluoride area and 48.6% for the non-fluoride location. CONCLUSION: The children living in the well-established fluoridated area had less dental caries and a higher proportion free from disease when compared with the other two areas which were not fluoridated. Fluoridation demonstrated a clear benefit in terms of better oral health for young children.