Digital Mammography Combined With Tomosynthesis: Improving Breast Cancer Detection

Contributed by Amy Argus, MD

MammogramMammography is key to detecting breast cancer early, and recent studies have shown that adding tomosynthesis to mammography increases cancer detection and reduces false positive results.

The tomosynthesis procedure is much like a routine mammogram, except that in mammography the machine is stationary, producing a flat 2-dimensional image, and in tomosynthesis the machine moves across the breast to produce multiple thin images, much like pages in a book, resulting in a final 3-D image of the breast tissue. In fact, tomosynthsesis is also sometimes referred to as 3-D mammography.

Tomosynthesis was approved by the FDA in the United States in 2011. It was only approved to be used in addition to a routine mammogram for breast cancer screening, as studies have shown the best cancer detection occurs with the combination of the two tests. The advent of tomosynthesis is significant because it improves all the areas that have received criticism in the past regarding traditional mammography: the production of excessive false-positive results, limited sensitivity and the potential of over-diagnosis of insignificant lesions.

In a recent multicenter analysis, the performance of digital mammography plus tomosynthesis was compared with that of digital mammography alone across a number of radiology practices in the United States.

Adding tomosynthesis lowered recall rates, sparing some women the frightening experience of receiving a false-postitive result. With digital mammography alone, for every 1000 women, 107 women were called back for more images. When tomosynthesis was added, the figure dropped to 91 in 1000, a 15% decrease.

Some criticize mammography for over-detection, meaning that some cancers found by mammograms will never become harmful, though the mammogram is limited in its ability to distinguish between dangerous and unthreatening lesions. In truth, most invasive breast cancers will progress and cause harm if left untreated, while a small percentage of non-invasive cancers, such as some instances of Ductal Carcinoma In-situ (DCIS), will not. In this study, the addition of tomosynthesis improved the detection of invasive cancers by about 40%, while the number of DCIS lesions found remained the same. Thus, tomosynthesis only improved the detection of clinically important cancers.

Furthermore, the benefits of adding tomosynthesis to mammography do not come with any increased radiation risks for the patient. The total dose of the x-rays use in tomosynthesis equals that used to create the flat picture for a standard mammogram, resulting in a total radiation dose approximately twice the current digital mammography dose. Even this amount of radiation, thankfully, is still well below the limits defined as safe by the FDA.

As results look more and more promising, mammography centers increasingly are purchasing tomosynthesis equipment, which is far more costly than the standard mammography unit. Unfortunately, many insurers do not cover the additional cost of testing, and some centers may require patients to pay an extra fee of about $50 to add tomosynthesis to a mammogram. At UC Health, however, we do not want cost to affect any woman’s ability to benefit from the addition of tomosynthesis to the traditional mammogram, and so we offer the advantage of this combined test at no additional charge to you.

Maintaining your breast health is important. Our comprehensive breast health program is staffed with specialists in breast radiology, surgery, oncology and genetics. We perform tomosynthesis, digital mammography, MRI, ultrasound, breast biopsy and localization and ductography/galactography. Integrative medicine services, including condition-focused classes for breast cancer survivors, are also available. If you would like to schedule an appointment with one of our providers, please call (513) 474-UC4U.

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