Reducing Mammogram Errors and Anxiety

Digital breast tomosynthesis may reduce mammography

(RxWiki News) Very little is more unnerving for a woman than to be called back for more tests after a mammogram.  Fear — maybe even panic — sets in.  A new technology may cut down on these recalls and the anxiety they cause.

According to a recent study, when digital mammography is combined with new screening technology called digital breast tomosynthesis (DBT), recall rates plummet.

Tomosynthesis was especially helpful in reducing the recall rates of younger women and women with dense (less fatty) breasts.

The authors of this study said this technology, when adopted for wider use, will help to eliminate the anxiety associated with mammography recalls, while improving screening accuracy.

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For this study, Brian M. Haas, MD, from the Department of Diagnostic Radiology at Yale University School of Medicine in New Haven, Conn., and colleagues compared screening recall rates and cancer detection rates between standard digital mammography and digital mammography combined with DBT.

When something looks suspicious on a mammogram, a woman is told to return for additional tests or possibly a biopsy, during which tiny samples of tissue are taken to look for cancer.

dailyRx News spoke with the inventor of digital breast tomosynthesis, Daniel B. Kopans, MD, professor of radiology at Harvard Medical School and senior radiologist at the Breast Imaging Division at Massachusetts General Hospital.

“We predicted that the use of DBT for screening would reduce the recall rate and increase the cancer detection rate relative to conventional two-dimensional mammography.  Other studies, and now this one from Yale, have confirmed our original expectations,” said Dr. Kopans, who was not involved in this study.

DBT is like conventional two-dimensional (2D) mammography in that it takes a picture of the breast tissue using radiation. Tomosynthesis goes further to construct a three-dimensional (3D) image that can be viewed as layers or “slices” of the breast tissue.

The researchers worked with 13,158 women who received digital mammography or mammography plus DBT at four clinical sites between October 1, 2011 and September 30, 2012.  A total of 6,100 women received both the digital mammogram and DBT.

The study found that the addition of DBT reduced the recall rate, while increasing cancer detection.

More specifically:

  • DBT reduced recall rate from 12.0 percent in the mammography only group to 8.4 percent in the tomosynthesis group. This equates to a 30 percent reduction in the recall rate.
  • For women with extremely dense breasts, the recall rate was 10.2 percent for those who received both screens, compared to 16.7 percent for those who had mammography only.
  • Women under the age of 40 benefitted from DBT, with an 11 percent recall rate for those who had both screens, compared to 25 percent among women who had only mammograms.
  • Cancer detection was 5.7 per 1,000 women in patients who had DBT compared with 5.2 per 1,000 women in patients who had digital mammography only.

“Decreased recall rates can be directly translated into less patient anxiety and decreased costs for additional diagnostic examinations,” the authors wrote.

One downside the researchers found was that the DBT with a digital mammogram essentially doubled the amount of radiation a woman received compared to a mammogram alone.

The US Food and Drug Administration (FDA) has approved technology designed to reduce radiation exposure.

“This [technology] will eliminate the need for acquiring full dose 2D mammograms with the DBT projection images, and the dose for DBT will be comparable to 2D mammography,” Dr. Kopans said. “This will allow DBT to replace 2D mammography for breast cancer screening to increase cancer detection while reducing recalls from screening and, hopefully, further reduce the death rate from breast cancer.”

This study was published July 29 in the journal Radiology.

No funding information was provided. No conflicts of information were disclosed.

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Review Date: 
July 29, 2013