Awareness of digital tomosynthesis and attitudes towards breast cancer early diagnosis in women at first screening: findings from the IMPETO trial survey

Background. The European guidelines on breast cancer and diagnosis recommend digital mammography (DM) or digital breast tomosynthesis (DBT) for screening asymptomatic women with an average risk of breast cancer. The research project innovation
in mammography: tomosynthesis pathways (IMPETO) includes an interventional randomised trial conducted in Tuscany, Italy, aiming to assess the feasibility and impact of DBT in screening. Limited evidence exists on women’s preferences and acceptability of
this new technology. To address this gap, as part of the IMPETO trial, a questionnaire was administered to 441 women aged 45 at their first inclusion in the screening programme, to investigate women’s awareness of tomosynthesis and their attitudes toward early diagnosis.
Methods. This cross-sectional study was nested within the IMPETO trial, whose participants were randomly sampled. From October 2021 to February 2022 all women who  participated in the face-to-face enrolment for the IMPETO trial were asked to fill out a structured questionnaire collecting socio-demographic information and assessing awareness of tomosynthesis, breast density, attitudes toward breast cancer early diagnosis, and sources of information on breast health. Multiple logistic regression was performed to identify predictors of tomosynthesis awareness and attitudes toward early diagnosis.
Results. Out of the 441 women surveyed, only 12% knew what tomosynthesis was and this awareness was positively associated with prior mammography experience (OR=2.092; 95% CI: 1.036-4.11). More than half of the participants (56.7%) had undergone mammography before joining the screening programme. Education attainment emerged as a significant predictor, with women holding a secondary degree being more likely to undergo mammography before age 45 (OR=2.18; 95% CI: 1.04-4.56). Among
those who had undergone mammography before 45, 38.8% were advised by their gynaecologist, 27.6% made the decision independently, and 13.6% followed the advice of their general practitioner.
Conclusion. This study highlights the need for improved education on screening appropriateness and associated risks and the importance of tailored communication to reduce knowledge differences across educational levels without increasing inappropriate use.