With 27 states now requiring providers to inform their patients if they have dense breasts, the industry is trying to determine the best supplemental tool for mammography. Last week, University of California, Davis (UC Davis) Dean's Professor of Biostatistics, Diana Miglioretti, was awarded $7.5 million to evaluate the options.

Standard 2-D mammography has limitations including missing some cancers and falsely recalling about 10 to 12 percent of women without cancer.

"These limitations occur more frequently in women with dense breast tissue, which can mask cancers or create concerning findings on the image that need further work-up to determine if it is cancerous," Miglioretti told HCB News.
The two modalities she will be focusing on are digital breast tomosynthesis and MR. Along with her fellow researchers, she will use data from the Breast Cancer Surveillance Consortium (BCSC), which is the biggest collection of information on breast imaging in the country.

Digital breast tomosynthesis may improve cancer detection and reduce false alarms, but it's not clear which women might benefit from this new technology or whether some women may even be harmed or pay unnecessary costs, said Miglioretti.

"Digital mammography may work as well as tomosynthesis in women with fatty breasts. And early evidence suggests tomosynthesis might increase biopsies, especially surgical biopsies, in some women without cancer," she added.

In addition, tomosynthesis costs about $50 extra per screening, which might not be covered by health insurance.

Supplemental screening with MR is already being used for women with dense breast tissue, especially those with other risk factors. But MR research has only focused on high-risk women, so it's not clear if women with dense breast who are not otherwise at high risk would benefit from this technology.

"MRI has high sensitivity but also results in a large number of benign biopsies, so it is important to quantify this benefit-harm trade-off in the general population of women with dense breasts," said Miglioretti.

The researchers will also investigate whether using MR before surgery improves surgical planning in women with newly-diagnosed breast cancer, and if it reduces the rate of breast cancer recurrence.

This award was one of four that the Patient-Centered Outcomes Research Institute (PCORI) Board of Governors gave out. This is one of the many awards that Miglioretti has received to use BCBS data to evaluate breast screening strategies.

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