This study is a randomized, multicenter, multivendor, controlled, diagnostic superiority trial to compare digital breast tomosynthesis plus synthesized 2D mammograms (DBT+s2D) versus standard 2D full-field digital mammography (2D-FFDM) regarding the effectiveness as screening modality.
The primary objective of the study is to evaluate whether digital breast tomosynthesis plus synthesized 2D mammograms leads to a relevant increase in the detection rate of screening-detected invasive cancers compared to 2D full-field digital mammography in routine screening according to the European Guidelines. Furthermore, the incidence rate of interval cancers within a 24 months interval after screening will be compared between both study arms in order to investigate the potential for overdiagnosis. According to the pre-defined order of both primary endpoints and the primary objective of the study in the planning phase, the initial sample size calculation was based solely on the first primary endpoint (invasive breast cancer detection rate). Given the increasing national and international attention of interval cancers to assess the impact of potential overdiagnosis caused by tomosynthesis, we have planned a sample size increase from 80,000 to 120,000 study participants to achieve a reasonable statistical power for the evaluation of both primary endpoints. The revised sample size calculation was carried out without knowledge of the data from the currently recruiting TOSYMA study, i.e. all planning assumptions were based on external data that do not belong to the ongoing study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SCREENING
Masking
NONE
Enrollment
99,689
Detection rate of invasive breast cancers
Number of women with screening-detected invasive breast cancer divided by the number of all women screened. A screening-detected breast cancer is classified as invasive carcinoma if the pT category (pathological tumor size) of the TNM classification falls into one of the following categories: pT1mic, pT1a, pT1b, pT1c, pT1, pT2, pT3, pT4a, pT4b, pT4c, pT4d, pT4, pTX (for evaluation purpose pTX defines histologically approved invasive breast cancer with missing tumor diameter) or the final pathological categorization has been done after neoadjuvant therapy (ypT), implying an invasive cancer prior to therapy.
Time frame: Routine screening visit
Cumulative 24 months incidence of interval cancers
The 24 months incidence of interval cancers is defined as the number of women that develop a ductal carcinoma in situ or an invasive breast cancer in the 24 months interval after a negative screening examination divided by the number of all women with a negative screening result.
Time frame: 24 months after routine screening visit
Detection rate of ductal carcinoma in situ (DCIS)
Number of women with screening-detected ductal carcinoma in situ (if the pT category of the TNM classification falls into the category pTis) divided by the number of all women screened.
Time frame: Routine screening visit
Detection rate of tumor category pT1
Number of women with screening-detected invasive breast cancers of the category pT1 divided by the number of all women screened. A screening-detected breast cancer is classified as breast cancer of tumor category pT1 if tumor size is ≤ 20 mm in greatest dimension and the respective pT subcategory of the pTNM classification is one of the following: pT1mic, pT1a, pT1b, pT1c, pT1.
Time frame: Routine screening visit
Recall rate for further assessment
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Screening-Einheit Hannover; Mammographie-Einheit Hannover
Hanover, Lower Saxony, Germany
Screening-Einheit Niedersachsen Nordost; Mammographie-Einheit Lüneburg
Lüneburg, Lower Saxony, Germany
Screening-Einheit Niedersachsen Nord; Mammographie-Einheit Stade
Stade, Lower Saxony, Germany
Screening-Einheit Niedersachsen Mitte; Mammographie-Einheit Vechta
Vechta, Lower Saxony, Germany
Screening-Einheit Niedersachsen Nordwest; Mammographie-Einheit Wilhelmshaven
Wilhelmshaven, Lower Saxony, Germany
Screening-Einheit Aachen-Düren-Heinsberg; Mammographie-Einheit Aachen
Aachen, North Rhine-Westphalia, Germany
Referenz-Screening-Einheit Münster-Nord/Warendorf; Mammographie-Einheit Ahlen
Ahlen, North Rhine-Westphalia, Germany
Screening-Einheit Köln rechtsrheinisch, Leverkusen, Rhein.-Berg. Kreis, Oberbergischer Kreis; Mammographie-Einheit Bergisch Gladbach
Bergisch Gladbach, North Rhine-Westphalia, Germany
Screening-Einheit Bielefeld, Gütersloh; Mammographie-Einheit Bielefeld
Bielefeld, North Rhine-Westphalia, Germany
Screening-Einheit Münster-Süd; Mammographie-Einheit Coesfeld
Coesfeld, North Rhine-Westphalia, Germany
...and 11 more locations
Number of women with recalls for further assessment divided by the number of all women screened.
Time frame: Routine Screening Visit
Positive predictive value of recall for further assessment (PPV1)
Number of women with screening-detected malignancies (ductal carcinoma in situ or invasive breast cancer) divided by the number of women with recalls for further assessment.
Time frame: Routine screening visit
Cumulative 12 months incidence of interval cancers
The 12 months incidence of interval cancers is defined as the number of women that develop a ductal carcinoma in situ or an invasive breast cancer in the 12 months interval after a negative screening examination divided by the number of all women with a negative screening result.
Time frame: 12 months after routine screening visit