From the July 2019 issue of HealthCare Business News magazine

Early on in our adoption process, we thought that only women with heterogeneously dense or extremely dense breast tissue would truly benefit from DBT. However, we detected just as many cancers that would’ve otherwise been overlooked in women with fatty and scattered fibroglandular tissue. This proved that all of our patients could benefit from DBT as their first step of initial screening. Other changes included sending patients directly to ultrasound from screening due to increased confidence in the reproducibility of a mass on DBT.

Although, at this point, a skeptic may argue that screening all patients with DBT leads to overdiagnosis, the truth is that overdiagnosis exists in theory at most. Radiologists cannot predict the biological activity of an imaging finding. We are unable to determine which areas of atypia won’t progress to cancer or which low-grade cancers won’t become more aggressive over time.


Additionally, 3D technology will only continue to advance. In fact, the newest adoption program I am working on offers high-resolution 3D images with synthetic 2D images and up to a 40 percent reduction in dose. These changes address concerns from critics of mammography and patients alike and helps to break down one of the barriers to screening.

As I reflect upon my personal DBT adoption experiences, I am reminded of the many patients who were able to receive a cancer diagnosis and begin treatment, all because of the screening technology that was available to them. Likewise, I am reminded of how these positive outcomes are not only priceless for patients themselves but also valuable performance metrics for me and my facility. As the medical director of a new breast program, The Breast Center CARTI, these factors are what drive me to continue to implement DBT programs. They are also what radiologists who have not yet adopted DBT should consider as they look to the future of patient care.

About the author: Stacy A. Smith-Foley, MD is medical director of The Breast Center at CARTI. She has more than a decade of clinical experience as a dedicated breast imager practicing in Arkansas, Oklahoma and South Carolina. She is a leader in her field as an active member of the Hologic Scientific Advisory Board, the Society of Breast Imaging and the National Consortium of Breast Centers. She is on the speaker’s bureau for Myriad Genetic Laboratories, Inc.

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July 2019 Magazine

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