Tomosynthesis detects more breast cancer in screening

Tomosynthesis detects 40% more breast cancers than traditional mammography does, according to a major screening study published in European Radiology (2014; doi:10.1007/s00330-015-3803-3). This is the first large-scale study to compare the screening method with regular mammograms. The 3D radiography technique is also more comfortable for women, as breast compression is halved.

A total of 7,500 women age 40 to 74 years took part in the first half of the study, which formed the basis for the findings.

"We see a change as inevitable. Breast tomosynthesis will be introduced, it is just a question of when and on what scale," explained Sophia Zackrisson, MD, PhD, and Kristina Lång, MD, radiologists at Skåne University Hospital in Malmö and researchers at Lund University in Sweden.

Breast tomosynthesis is a three-dimensional radiography technique that makes it easier to detect tumors in breast tissue. The technique works on the same principle as tomography. This means that radiographic images of the breast are acquired from different angles, which can then show multiple thin layers of the breast. This is compared with a traditional mammography, where all the breast tissue is reproduced in a single image, which can hinder the early detection of tumors.

The new technique also reduces discomfort and pain, because the breast does not have to be compressed as firmly as in the current examination technique. This could lead to higher levels of participation in future screening programs.

Among the other advantages are lower radiation doses than in traditional mammography, and the ready availability of the equipment on the market, which would facilitate a transition.

However, there are a few challenges remaining before the method can be introduced on a large scale. As with other screening methods, there is a risk of overdiagnosis (in mammography screening, the figure is 10% to 20%). The researchers do not know what that number is for tomosynthesis, and further studies are needed to investigate the rate of overdiagnosis with tomosynthesis.

The study found that there was an increase in recall rates, meaning more healthy women with benign lesions were recalled for further testing. This is a drawback in screening, said Kristina Lång, as it can cause unnecessary psychological stress.

The ongoing research will also look at costs. Breast tomosynthesis is a somewhat more expensive technique.

"We see 5 to 10 years from now as a possible timeframe for the large-scale introduction of the technique. There is also an aspiration for more personalized screening, and breast tomosynthesis could therefore be one of several methods used," concluded Sophia Zackrisson.

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