A new study has indicated that the new 3D imaging technique of tomosynthesis has made the detection of breast cancer more accurate in comparison to the conventional digital mammography. According to a new study, 3D mammograms can increase the detection rate of breast cancer as well as decrease the rate of false alarms.
The study published in The Journal of the American Medical Association (JAMA) has found that though digital tomosynthesis is not yet widely available, it has been linked to a reduction in the number of patients being called back for additional testing and improved breast cancer detection rates. The relatively new 3D mammogram technique, digital tomosynthesis was approved by the US Food and Drug Administration (FDA) in 2011 after standard digital mammogram were increasingly being criticized for producing too many false-positive results, having limited sensitivity and for, at times, over-diagnosing clinically insignificant lesions.
Currently the main method of screening for breast cancer, mammograms have been shown to lower the risk of dying from breast cancer by 35 percent in women over the age of 50, according to Breastcancer.org. While, the compression of the breast can also be uncomfortable and occasionally hide lesions in overlapping tissue that will not appear on a mammogram, in the tomosynthesis technique, only a small amount of pressure is applied. The technique involves taking multiple x-ray images from different angles and using them to produce 3-D images throughout the entire breast, instead of a single one that conventional mammograms do. However, some experts warn that the study did not include long term follow up information so some doubts over the most effective method for cancer detection still remain.
When compared to regular mammograms, tomosynthesis detected 41 percent more invasive cancer and required 15 percent fewer repeat scans. However, the test has not been around long enough to determine whether it saves lives or misses tumors. With tomosynthesis, there were more biopsies: 19.3 per 1,000 scans, versus 18.1 with digital mammography. Other findings were expressed in percentages. With digital mammography alone, 4.3 percent of the women called back turned out to have cancer but the rate was 6.4 with the tests combined.
The addition of 3-D mammography to conventional digital mammography substantially improved detection of invasive breast cancers and reduced the number of women called back for re-examination, according to the first large study of the new technology released Tuesday.
Although tomosynthesis resulted in more biopsies, more were positive for cancer: 29.2 percent versus 24.2 percent with digital mammography alone.
Predictably, tomosynthesis is more expensive and it’s not always covered by insurance. Typically, it may involve an additional $50 – $75 per test.
There was no difference in discovery of ductal carcinoma in situ, a condition that is the subject of heated debate concerning over diagnosis and overtreatment of some breast cancers.
Breast cancer kills 40,000 women annually, according to the American Cancer Society, although screening mammography has been important in reducing the mortality rate. But in recent years, women have been subjected to a confusing outpouring of information and research on who should be screened for breast cancer, when and how often. In July, a committee of the National Cancer Institute warned of over diagnosis and overtreatment of some cancers, suggesting a name change for ductal carcinoma in situ, which is not invasive and the committee said, should not be labeled a cancer. In recent years, influential medical boards in the United States, Canada and Switzerland have revised their recommendations on screening mammography as debate continued over false positive findings and overdiagnosis.
In an editorial that accompanied the 3-D mammography study Tuesday, two physicians who were not involved in the research suggested that the results will renew debate, this time over whether tomosynthesis should replace digital mammography, the way that technology replaced X-ray film. They called for more study.
Previous studies have reached similar conclusions as Tuesday’s paper about the value of 3-D mammography but all were from single sites and so of limited value. The research released Tuesday was retrospective and so was not correlated with patient outcomes.
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