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Digital mammography in conjunction with tomosynthesis detects 90 percent more cancers than 2D alone — but 3D comes with a set of challenges.
According to a new study published in Radiology, those challenges include an increase in overdiagnosis and reading time.
The final results are still pending, but Dr. Paolo Giorgi Rossi of ASUL Reggio Emilia in Italy told HCB News that a relevant increase in overdiagnosis would be very difficult to mitigate.
"This mitigation can only come from less and less invasive treatment for ductal carcinaomas in situ, lesions with uncertain risk of malignancy or low risk cancers," he added.
However, for the reading time there are many promising technologies that could increase performance and sustainability of the screening program. Those include new visualization protocols, faster software, increasing the interval between two rounds of screening, and changing the roles regarding double reading.
"If the improvement in sensitivity is so high and corresponds to an improvement in mortality, there is room for many measures to maintain an acceptable efficiency or even to increase efficiency of screening," said Giorgi Rossi.
For the study, Giorgi Rossi and his team compared results between 9,777 women randomized to receive digital mammography and tomosynthesis and 9,783 randomized to undergo digital mammography alone.
They found that the combination of digital mammography and tomosynthesis detected 8.6 cancers per 1,000 cases. That is almost double the 4.5 cancers per 1,000 cancers that digital mammography alone detected.
The team also found that tomosynthesis alone detected 72 of the 80 cancers that digital mammography and tomosynthesis found together. This increased detection rate for combined digital mammography and tomosynthesis was notable for small and medium invasive cancers, but not for large ones.
The new research is part of a preliminary analysis from a larger study in which researchers will be evaluating cancer detected between screening exams and the cumulative incidence of advanced cancers. In order to achieve more precise outcome estimates, the team is promoting a network of ongoing trials across Europe with a similar study design.
