Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), University of Modena and Reggio Emilia, Modena, Italy.
Radiol Med. 2024 Aug;129(8):1156-1172. doi: 10.1007/s11547-024-01849-0. Epub 2024 Jul 23.
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.
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.
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.
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.
我们全面研究了在意大利将数字乳腺断层摄影术（DBT）作为乳腺癌筛查的主要检测手段所带来的组织、社会和伦理影响。分析旨在评估 DBT 对所有 45-74 岁女性、45-49 岁女性或乳腺致密的女性进行特定筛查的可行性。
根据欧洲卫生技术评估网络（EuNetHTA）筛查核心模型提出问题，为分级评估、制定和评价（GRADE）决策框架的资源、公平性、可接受性和可行性领域提供证据。该研究综合了文献、MAITA DBT 试验和意大利试点项目的证据。采用结构化访谈、调查和系统评价收集有关组织影响、女性接受度、阅读和获取时间以及筛查中 DBT 的技术要求的数据。
实施 DBT 可能会显著影响筛查计划，主要是因为阅读时间增加和需要额外的人力资源（放射科医生和放射技师）。DBT 筛查的参与率与标准数字乳腺摄影相似，如果不是更好，表明女性的接受度良好。该研究还强调了对放射技师进行特定培训的必要性。受访的关键人员一致认为，基于乳腺密度或年龄的定制化筛查策略是可行的，但需要与目标人群进行有效的沟通。
放射科医生和放射技师工作量的增加限制了 DBT 筛查的可行性。量身定制的筛查策略可以在最大限度地发挥 DBT 优势的同时减轻潜在挑战。
