This study compares **Digital Tomosynthesis Mammography (TM)** and **Digital Mammography (DM)** for breast cancer screening to see which is better at finding cancer and reducing extra tests or treatments. TM is a newer type of mammogram that takes multiple X-ray pictures from different angles to create a 3D image of the breast, which may help doctors see cancers more clearly than DM, which takes a single, flat picture. **Key Points:** - **Study Duration and Visits:** Participants will have screening at different times over 4.5 years, with follow-ups for at least 3 to 8 years. - **Eligibility:** Women must not be pregnant, should be planning a mammogram, and cannot have recent breast cancer or enhancements like implants. - **Benefits and Risks:** The study aims to find which method detects cancer better and to understand effects on health care use and cost. Participants will randomly be assigned to get either TM or DM screenings. The study will help determine the best screening method based on factors like age, breast density, and family history, and will consider the cost and quality of each method.