Ever since breast tomosynthesis was introduced, researchers have endeavored to not only define its benefits, but determine the patient populations best suited to receive it. A new study published yesterday in JAMA is adding to that body of evidence, and has determined that the modality reduces recall rates and increases the detection of invasive breast cancer in women with dense and non-dense breasts, alike.

"Our study answered the critical question of who should be imaged with tomosynthesis, providing compelling evidence that all women undergoing mammographic screening should be imaged with tomosynthesis, regardless of their breast density," Dr. Elizabeth Rafferty, the lead investigator of the study, told HCB News.

Breast density is a major hurdle in the breast imaging field because with conventional mammography, it obscures the images and hides the cancer, which can result in additional visits and exams for the patients. To date, 26 states have passed laws that require physicians to inform their patients if they have dense breasts.
The study involved the principal investigators from a groundbreaking breast tomosynthesis study conducted in 2014 that was also published in JAMA. For this new study, the researchers evaluated 278,906 conventional mammograms and 173,414 breast tomosynthesis exams conducted with Hologic’s Selenia Dimensions tomosynthesis system.

They found that the improvements in recall rate reduction and invasive cancer detection were greatest among women with heterogeneously dense breasts, which make up 40 percent of the screening population in the U.S. Among that group, there was a 50 percent increase in invasive cancer detection and a simultaneous 14 percent reduction in recall rate.

For women with non-dense breast tissue, 30 percent more invasive cancers were found, and unnecessary additional tests were reduced by 13 percent.

"As physicians, we want the best possible test for our patients, and for breast cancer screening, it is clear that today that test is tomosynthesis," said Rafferty. "Doctors should seek it out for their patients and women should seek it out for themselves."

Even though many studies highlight its effectiveness for detecting cancer in women with dense breasts, tomosynthesis is not the only alternative to traditional mammography that has shown success. Molecular breast imaging (MBI), which is a very sensitive and specific exam that relies on functional imaging technology, may also improve screening for that patient population.

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