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Special report: The end of traditional mammography?

by Carol Ko, Staff Writer | July 19, 2013
International Day of Radiology 2012
From the July 2013 issue of HealthCare Business News magazine

One study of thousands of patients showed that mammograms missed 40 percent of cancers in women with dense breast tissue that were found on ultrasound. Other studies have showed similar results. Yet, while it’s well-established now that breast density is, broadly speaking, associated with higher cancer risks, researchers have still not reached an official consensus what women should do to alleviate those risks.

The research community’s reservations haven’t stopped lawmakers from moving forward with legislation. Connecticut enacted a law in 2010 that requires providers to inform women in writing that they have dense breasts after one patient with dense breasts died of a missed detection, and in total, seven other states have passed similar laws.

While most physicians are in favor of informing patients, they’re also wary of giving them directives that have not yet been backed by evidence. “There is no evidence that supplemental screening would improve outcomes. Informing patients is necessary but adding language about supplemental studies could mislead patients into thinking that their outcomes could be improved through these studies,” says Dr. Christoph Lee, assistant professor at University of Washington.

Studies show that ultrasounds and MRIs may be more effective at spotting breast cancer, with ultrasounds finding three to four additional cancers per 1,000 women with dense breasts that mammograms miss. However, those tests are usually reserved for high-risk women with dense breasts, and using them in conjunction with 2-D mammograms may add considerably to the cost of breast cancer screening.

Since sliced bread
Digital breast tomosynthesis is an imaging technique that many breast imaging experts agree will help improve breast screenings moving forward. “Tomosynthesis is the most promising technology right now — it’s a hot topic,” says Dr. Jennifer Drukteinis, lead author of an overview published in April 2012 of new breast imaging technologies in the pipeline for dense breasts. Hologic is currently the only company offering this technology in the U.S.

Tomosynthesis produces tomographic “slices” of an entire tissue volume, similar to a CT scan, using a single acquisition. This enables doctors to view the breast as individual slices, eliminating the overlap that may hide a cancer in a woman with very dense breasts and thereby reducing false positives. “Digital tomosynthesis cut down false positive callbacks by 24% in our first year and increased our cancer detection rate. So when you look at the risk/benefit balance, that risk has been decreased and the balance is statistically better,” says University of Pennsylvania’s Conant.

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