Organizational impact of systemic implementation of digital breast tomosynthesis as a primary test for breast cancer screening in Italy

期刊论文
发表日期：

2024年7月23日

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Olivera Djuric,
Silvia Deandrea,
Paola Mantellini,
Francesco Sardanelli,
Francesco Venturelli,
Stefania Montemezzi,
Riccardo Vecchio,
Lauro Bucchi,
Carlo Senore,
Livia Giordano,
Eugenio Paci,
Adriana Bonifacino,
Massimo Calabrese,
Francesca Caumo,
Flori Degrassi,
Priscilla Sassoli de’ Bianchi,
Francesca Battisti,
Marco Zappa,
Pierpaolo Pattacini,
Cinzia Campari,
Andrea Nitrosi,
Giovanni Di Leo,
Alfonso Frigerio,
Veronica Magni,
Francesca Fornasa,
Giovanna Romanucci,
Patrizia Falini,
Noemi Auzzi,
Paola Armaroli,
Paolo Giorgi Rossi,
Chiara Coriani,
Manuela Pescarolo,
Gloria Stefanelli,
Giulio Tondelli,
Filippo Beretti,
Sabrina Caffarri,
Vanessa Marchesi,
Laura Canovi,
Marco Colli,
Mirco Boschini,
Marco Bertolini,
Moira Ragazzi,
Pierpaolo Pattacini,
Paolo Giorgi Rossi,
Valentina Iotti,
Vladimiro Ginocchi,
Sara Ravaioli,
Rita Vacondio,
Cinzia Campari,
Stefania Caroli,
Andrea Nitrosi,
Luca Braglia,
Silvio Cavuto,
Pamela Mancuso,
Olivera Djuric,
Francesco Venturelli,
Massimo Vicentini,
Maria Barbara Braghiroli,
Annamaria Pezzarossi,
Jasmine Lonetti,
Elena Davoli,
Efrem Bonelli,
Francesca Fornasa,
Giovanna Romanucci,
Ilaria Lucchi,
Gessica Martello,
Claudia Rossati,
Stefania Montemezzi,
Paola Mantellini,
Daniela Ambrogetti,
Anna Iossa,
Eva Carnesciali,
Vincenzo Mazzalupo,
Patrizia Falini,
Donella Puliti,
Marco Zappa,
Francesca Battisti,
Noemi Auzzi,
Simona Verdi,
Carolina Degl’Innocenti,
Daniela Tramalloni,
Elena Cavazza,
Simone Busoni,
Elisa Betti,
Fiorella Ciuffi,
Francesca Peruzzi,
Francesco Regini,
Francesco Sardanelli,
Giovanni Di Leo,
Luca Alessandro Carbonaro,
Veronica Magni,
Andrea Cozzi,
Diana Spinelli,
Cristian Giuseppe Monaco,
Simone Schiaffino,
Adrienn Benedek,
Laura Menicagli,
Raffaella Ferraris,
Elisabetta Favettini,
Davide Dettori,
Paolo Falco,
Pietro Presti,
Nereo Segnan,
Antonio Ponti,
Alfonso Frigerio,
Paola Armaroli,
Loredana Correale,
Vincenzo Marra,
Luisella Milanesio,
Franca Artuso,
Aurora Di Leo,
Isabella Castellano,
Emilia Riggi,
Denise Casella,
Sabina Pitarella,
Viviana Vergini,
Livia Giordano,
Stephen W. Duffy,
Axel Graewingholt,
Kristina Lang,
Fabio Falcini,
Daniela Ambrogetti,
Laura Bonvicini,
Beniamino Brancato,
Matteo Capobussi,
Eva Carnesciali,
Marco Moschetta,
Elena Parmelli,
Loredana Pau,
Stella Pedilarco,
Francesca Pietribiasi,
Stefano Ferretti

摘要

Purpose

We present a comprehensive investigation into the organizational, social, and ethical impact of implementing digital breast tomosynthesis (DBT) as a primary test for breast cancer screening in Italy. The analyses aimed to assess the feasibility of DBT specifically for all women aged 45–74, women aged 45–49 only, or those with dense breasts only.

Methods

Questions were framed according to the European Network of Health Technology Assessment (EuNetHTA) Screening Core Model to produce evidence for the resources, equity, acceptability, and feasibility domains of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) decision framework. The study integrated evidence from the literature, the MAITA DBT trials, and Italian pilot programs. Structured interviews, surveys, and systematic reviews were conducted to gather data on organizational impact, acceptability among women, reading and acquisition times, and the technical requirements of DBT in screening.

Results

Implementing DBT could significantly affect the screening program, primarily due to increased reading times and the need for additional human resources (radiologists and radiographers). Participation rates in DBT screening were similar, if not better, to those observed with standard digital mammography, indicating good acceptability among women. The study also highlighted the necessity for specific training for radiographers. The interviewed key persons unanimously considered feasible tailored screening strategies based on breast density or age, but they require effective communication with the target population.

Conclusions

An increase in radiologists’ and radiographers’ workload limits the feasibility of DBT screening. Tailored screening strategies may maximize the benefits of DBT while mitigating potential challenges.