Digital Tomosynthesis Mammography and Digital Mammography in Screening Patients for Breast Cancer

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Keywords/Phrases: ea1151
Status: Active


This randomized phase III trial studies digital tomosynthesis mammography and digital mammography in screening patients for breast cancer. Screening for breast cancer with tomosynthesis mammography may be superior to digital mammography for breast cancer screening and may help reduce the need for additional imaging or treatment.

Eligibility Criteria

Inclusion Criteria

  • Women of childbearing potential must not be known to be pregnant or lactating
  • Patients must be scheduled for, or have intent to schedule, a screening mammogram
  • Patients must be able to tolerate digital breast tomosynthesis and full-field digital mammographic imaging required by protocol
  • Patients must be willing and able to provide a written informed consent
  • Patients must not have symptoms or signs of benign or malignant breast disease (e.g., nipple discharge, breast lump); patients with breast pain are eligible as long as other criteria are met
  • Patients must not have had a screening mammogram within the last 11 months prior to date of randomization
  • Patients must not have previous personal history of breast cancer including ductal carcinoma in situ
  • Patients must not currently have breast enhancements (e.g., implants or injections)
  • To be eligible for inclusion in the annual screening regimen one of the following three conditions must be met in addition to the eligibility criteria above: * Patients are pre-menopausal; OR * Post-menopausal aged 45-69 with any of the following three risks factors: ** Dense breasts (BIRADS density categories c-heterogeneously dense or d-extremely dense), or ** Family history of breast cancer (first degree relative with breast cancer), or, positive genetic testing for any deleterious genes that indicate an increased risk for breast cancer, or ** Currently on hormone therapy; OR * Post-menopausal ages 70-74 with either of the following two risk factors: ** Dense breasts (BIRADS density categories c-heterogeneously dense or d-extremely dense), or ** Currently on hormone therapy
  • Postmenopausal women are defined as those with their last menstrual period more than 12 months prior to study entry; for the purpose of defining menopausal status for women who have had surgical cessation of their periods, women who no longer have menses due to hysterectomy and oophorectomy will be considered postmenopausal; women who no longer have menses due to hysterectomy without oophorectomy will be considered premenopausal until age 52 and postmenopausal thereafter
  • All other postmenopausal women are eligible for inclusion in the biennial screening regimen
  • For those women who cannot be assigned to annual or biennial screening at the time of study entry and randomization because they are postmenopausal, have no family history or known deleterious breast cancer mutation, are not on hormone therapy AND have not had a prior mammogram, breast density will be determined by the radiologist’s recording of it at the time of interpretation of the first study screening examination, either DM or TM; for those who are randomized to TM, radiologists will assign BI-RADS density through review of the DM or synthetic 2D portion of the TM examination; such women cannot be part of the planned stratification by screening frequency and are expected to represent far less than 1% of the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) population
  • Breast density will be determined by prior mammography reports, when available; all other risk factors used to determine patient eligibility for annual or biennial screening will be determined by subject self-report

Locations & Contacts


Scottsdale Medical Imaging Limited
Status: Active
Contact: Denise H. Reddy Email:


Kern Radiology Medical Group Inc
Status: Active
Contact: David Paul Schale
Phone: 661-326-9600


Colorado Springs
Penrose-Saint Francis Healthcare
Status: Active
Contact: Mehmet Sitki Copur
Phone: 303-777-2663 Email:
The Women's Imaging Center
Status: Active
Contact: Keren Sturtz Email:
Radiology Imaging Associates
Status: Active
Contact: Lora Duyan Barke Email:


Lewis Cancer and Research Pavilion at Saint Joseph's / Candler
Status: Active
Contact: Howard A. Zaren Email:


Carle Cancer Center
Status: Active
Contact: Kendrith M. Rowland
Phone: 800-446-5532


Indiana University / Melvin and Bren Simon Cancer Center
Status: Active
Contact: Steven M. Westphal Email:


Baton Rouge
Mary Bird Perkins Cancer Center
Status: Active
Contact: James F. Ruiz
Phone: 225-215-1353 Email:
Louisiana State University Health Sciences Center Shreveport
Status: Active
Contact: Jerry McLarty
Phone: 318-813-1412 Email:


Ann Arbor
University of Michigan Comprehensive Cancer Center
Status: Active
Contact: Stephanie Patterson
Phone: 800-865-1125


Carson City
Carson Tahoe Regional Medical Center
Status: Active
Contact: John Allan Ellerton
Phone: 702-384-0013

New York

Montefiore Medical Center-Einstein Campus
Status: Active
Contact: Beatriu Reig
Phone: 718-904-2730 Email:
Montefiore Medical Center-Weiler Hospital
Status: Temporarily closed to accrual
Contact: Beatriu Reig
Phone: 718-904-2730 Email:
Arnot Ogden Medical Center / Falck Cancer Center
Status: Active
Contact: Chi K. Tsang
Phone: 607-271-7000
New York
Columbia University / Herbert Irving Cancer Center
Status: Active
Contact: Ralph T. Wynn
Phone: 212-305-8615

North Carolina

Chapel Hill
UNC Lineberger Comprehensive Cancer Center
Status: Active
Contact: Cherie Kuzmiak
Phone: 877-668-0683 Email:


Aultman Health Foundation
Status: Active
Contact: Shruti Trehan
Phone: 330-363-6891


Easton Hospital
Status: Active
Contact: Rajen P. Oza
Phone: 610-250-4000

South Carolina

Mount Pleasant
MUSC Health East Cooper
Status: Active
Contact: Dag Pavic
Phone: 843-792-9321 Email:
Spartanburg Medical Center
Status: Active
Contact: Amarinthia (Amy) Curtis
Phone: 800-486-5941


Baptist Memorial Hospital and Cancer Center-Memphis
Status: Temporarily closed to accrual
Contact: Evelyn W. Gayden
Phone: 901-226-3077
Baptist Memorial Hospital for Women
Status: Active
Contact: Evelyn W. Gayden
Phone: 901-226-1493 Email:
Vanderbilt University / Ingram Cancer Center
Status: Active
Contact: Reagan Leverett
Phone: 800-811-8480


University of Virginia Cancer Center
Status: Active
Contact: Jennifer Ann Harvey
Phone: 434-243-6322 Email:
Sentara Leigh Hospital
Status: Active
Contact: John K. Plemmons
Phone: 757-388-5109 Email:
Sentara Norfolk General Hospital
Status: Active
Contact: John K. Plemmons
Phone: 757-388-2406


Ottawa Hospital and Cancer Center-General Campus
Status: Active
Contact: Jean M. Seely
Phone: 613-761-4395
Odette Cancer Centre- Sunnybrook Health Sciences Centre
Status: Active
Contact: Roberta Agnes Jong
Phone: 416-480-5000

Trial Objectives and Outline


I. To compare the proportions of participants in the tomosynthesis mammography (TM) and digital mammography (DM) study arms experiencing the occurrence of an “advanced” breast cancer at any time during a period of 4.5 years from randomization, including the period of active screening and a period of clinical follow-up after the last screen (T4).


I. To assess the potential effect of age, menopausal and hormonal status, breast density, and family cancer history on the primary endpoint difference between the two arms.

II. To compare the diagnostic performance of TM and DM, as measured by the area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

III. To compare the recall rates and biopsy rates for TM versus DM, with subset analyses by the same variables as listed in aim II.

IV. To compare the rate of interval cancers for TM and DM and to assess the mechanism of diagnosis for these interval cancers with categorization by symptomatic versus (vs) asymptomatic, and how detected: diagnosed via physical examination, mammography, ultrasound (US), magnetic resonance imaging (MRI) or other technologies.

V. To examine the correlation between Breast Imaging Reporting and Data System (BIRADS) imaging features and histologic and genetic features, such as invasive ductal and invasive lobular histology, high grade, high stage at diagnosis, and aggressive genetic subtypes.

VI. To assess different combinations of TM and synthesized 2 dimensional (2D) or DM in reader studies to assist in determining the optimum balance between diagnostic performance, radiation exposure and technique.

VII. To estimate and compare breast-cancer-specific mortality between the two study arms.

VIII. To estimate and compare the prevalence of breast cancer subtypes (luminal A, luminal B, HER2+, basal-like) low, medium or high proliferation via PAM50 proliferation signatures, and p53 mutant-like or wild-type-like according to a validated p53 dependent signature in the two arms, overall and stratified on whether cancers were detected through screening or as interval cancers, and whether cancers were invasive or in situ.

IX. To classify histologically malignant (true positive cases) and benign lesions (false positive cases) as normal-like or tumor-like using the PAM50 gene expression assay subtype (luminal A, luminal B, HER2, basal-like,), and low, medium, or high proliferation according to PAM50 proliferation signatures, and p53 mutant-like or wild-type-like according to a validated p53-dependent signature.

X. To assess the agreement between local and expert study pathologists for all breast lesions (benign and malignant) biopsied during the 4.5 years of screening with TM or DM.

XI. To create a blood and buccal cell biobank for future biomarker and genetic testing.

XII. To compare health care utilization (including cancer care received) and cost of an episode of breast cancer screening by TM versus DM, overall and within subsets.

XIII. To implement a centralized quality control (QC) monitoring program for both 2D digital mammography (DM) and tomosynthesis (TM), which provides rapid feedback on image quality, using quantitative tools, taking advantage of the automated analysis of digital images.

XIV. To assess temporal and site-to site variations in image quality, breast radiation dose, and other quality control parameters in TM vs. DM.

XV. To refine and implement task-based measures of image quality to assess the effects of technical parameters, including machine type, and detector spatial and contrast resolution on measures of diagnostic accuracy for TM.

XVI. To evaluate which QC tests are useful for determination of image quality and those that are predictive of device failure, in order to recommend an optimal QC program for TM.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM A: Patients undergo bilateral screening DM with standard craniocaudal (CC) and mediolateral oblique (MLO) views at baseline, 12, 24, 36, and 48 months if pre-menopausal or at baseline, 24, and 48 months if post-menopausal.

ARM B: Patients undergo manufacturer-defined screening TM at baseline, 12, 24, 36, and 48 months if pre-menopausal or at baseline, 24, and 48 months if post-menopausal.

After completion of study, patients are followed up for at least 4.5-8 years after study entry.

Trial Phase & Type

Trial Phase

Phase III

Trial Type


Lead Organization

Lead Organization
ECOG-ACRIN Cancer Research Group

Principal Investigator
Etta Driscoll Pisano

Trial IDs

Primary ID EA1151
Secondary IDs ECOG-ACRIN-EA1151, NCI-2017-01111 ID NCT03233191