and Medicine for Seniors
3D Mammography Offers New Hope for Women: Finds More
Invasive Cancers, Reduces Call-Backs
Largest study to date tested nearly half million
women; could lead to changes in standards of care
Emily F. Conant, M.D., Penn Medicine examines 3D mammography.
Study finds it detects more invasive cancers and reduces
call-back rates - published in JAMA.
June 25, 2014 - Researchers from Penn Medicine and
other institutions have found that 3D mammography - known as digital
breast tomosynthesis – will find significantly more invasive, or
potentially lethal, cancers than a traditional mammogram alone and
reduced call-backs for additional imaging. The study is reported today
in the Journal of the American Medical Association (JAMA).
This is the largest study reported to date - with
nearly a half a million women - measuring the effectiveness of the
technology, and could potentially lead to a change in the standard of
care for breast screening.
"It's the most exciting improvement to mammography
that I have seen in my career, even more important for women than the
conversion from film-screen mammography to digital mammography," said
Emily F. Conant, MD,
chief of Breast Imaging the department of Radiology at the
Perelman School of Medicine at the
University of Pennsylvania. "3D mammography finds more
clinically significant breast cancers earlier, which is the key so that
women have more treatment options and ultimately better health
In the retrospective study, the researchers looked
at 281,187 digital mammography examinations and 173,663 examinations
with both tomosynthesis and digital mammography between 2010 and 2012.
The data set included women from a wide range of breast cancer screening
programs that were both geographically diverse and included academic and
community practices, 13 in total.
Researchers found 41 percent more invasive cancers
when women were screened with tomosynthesis plus digital compared to
digital mammography alone. The use of tomosynthesis also reduced the
number of women called back for additional testing by 15 percent.
Conventional digital mammography is the most
widely-used screening modality for breast cancer, but may yield
suspicious findings that turn out not to be cancer, known as
false-positives. Such findings are associated with a higher recall rate,
or the rate at which women are called back for additional imaging or
biopsy that may be deemed unnecessary.
Tomosynthesis, however, allows for 3-D
reconstruction of the breast tissue, giving radiologists a clearer view
of the overlapping slices of breast tissue. And though a relatively new
technology, it has shown promise at reducing recall rates in all groups
of patients, including younger women and those with dense breast tissue,
and better detection rates in smaller studies. In 2011, tomosynthesis
was approved by the U.S. Food and Drug Administration to be used in
combination with standard digital mammography for breast cancer
3D mammography is the only method used for breast
cancer imaging that has demonstrated this combined benefit, the authors
report. While 3D mammography found more invasive cancers, detection of
in situ cancers (non-invasive cancers) was similar to a traditional
Since October 2011, all screening mammograms at
Penn Medicine's Perelman Center for Advanced Center now include
tomosynthesis according to Dr. Conant.
"The coming years will be very exciting, as we see
further improvements in this innovative technology," said Conant. "This
new technology will certainly change the way we screen women."
The study also included lead author Sarah M.
Friedewald, MD, of the Caldwell Breast Center at Advocate Lutheran
General Hospital; Elizabeth Rafferty, MD; Stephen L. Rose, MD; Melissa
Durand, MD; Donna Plecha, MD; Julianne Greenberg, MD; Mary K. Hayes, MD;
Debra S. Copit, MD; Kara Carlson, MD; Thomas Cink, MD; Lora Barke, MD;
Linda Greer, MD; and David Miller, MS.