Breast imaging options


Mammographic imaging options have expanded beyond the familiar two-dimemsional (2-D) radiographic film technology. Today, many U.S. mammography centers have installed digital radiographic mammography machines. Digital mammography is 2-D technology that still uses "X-rays to produce an image of the breast, but rather than a conventional mammography film format, the image is stored as digital data. This digital information can be enhanced, magnified, or manipulated for further evaluation more easily than information stored on film (NIH, 2014)." For most women there is little or no difference in the rate of cancer detection between film or digital technologies, but digital may be more sensitive in the case of women with dense breasts (Pisano, 2005; Kerlikowske, 2011).

A more recent technology applies a process similar to computed tomography (CT) scanner to produce multiple images of structures inside of the breast 3-D mammography, also referred to as breast tomosynthesis. In a process similar to This FDA approved mammographic technology compiles multiple images of the breast, creating a 3-D image of the breast. Several studies have found three-dimensional mammography to result in lower recall rates for more tests by 36% to 40% compared to conventional mammography. Cancer detection was significantly higher in the group of women who had 3D mammography, even with dense breasts (Houssami & Turner, 2016).

There are still some issues to be resolved with 3D mammography.  Not all insurances will pay for this new assessment yet.  There may be an additional cost to patients, some reporting $90. Some centers are recommending 3D mammography for women with dense breasts.  Other centers are recommending 3D mammography for all women.  Radiation exposure with the 3D mammography is slightly higher than the traditional mammogram procedure.  It is still within the safe limits recommended by the FDA (Bramlet, 2015; Olivero, 2015).

Tagliafico, et al. (2016) compared the results of standard mammography followed by ultra sound with 3D mammography results in women with dense breasts. They found 23 cancers detected using ultrasound and 13 detected using 3D in 3,231women with negative mammographic screening. These researchers concluded for women with dense breasts, mammography followed by ultrasound leads to better breast cancer detection then with 3D mammography, although 3D mammography leads to better detection than standard mammography.  Both 3D mammography and standard mammography followed by ultrasound have the same recall rate.

The Mayo Clinic reports the following additional supplemental screening tests and their ability to detect additional cancer.

Supplemental screening test
Pros
Cons
3-D Mammogram
  • Estimated to detect an 1-2 cancers per 1000 women
  • Done at the same time as standard mammogram
  • Reduces the need for additional testing for areas of concern that aren't cancer
  • Additional radiation but the levels are low
  • Not available everywhere but becoming more common
Breast MRI
  • Estimated to detect 18 or more additional cancer per 1000 women
  • No additional radiation exposure
  • Likely to find areas of concern that aren't cancer, but that require additional imaging or a biopsy
  • Requires injection of contrast material
  • Expensive test not often covered by insurance unless you have a very high risk of cancer
Breast ultrasound
  • Estimated to detect an additional 3-4 cancers per 1,000 women
  • No additional radiation exposure
  • Widely available
  • Likely to find areas of concern that aren't cancer, but that require additional imaging or a biopsy
  • Quality of exam dependent on experience of person doing the test
Molecular breast imaging
  • Estimated to detect an additional 7 cancers per 1,000 women
  • Less likely to find areas of concern that aren't cancer
  • Involves injection of a radioactive tracer, which exposes you to a very low level of radiation
  • Available at few medical centers
http://www.mayoclinic.org/tests-procedures/mammogram/in-depth/dense-breast-tissue/art-20123968?pg=2

2016 - U.S. Preventive Services Task Force (USPSTF) Breast Imaging Recommendations (Siu, 2016)

Siu, et al. (2016) from the U. S. Preventive Services Task Force (USPSTF) made the following recommendations for breast cancer screening.

It is important to note the USPSTF is not a government agency but an independent group. There are several organizations, the American College of Radiology (ACR) and Society of Breast Imaging (SBI) and the American Cancer Society who continue to recommend women obtain yearly mammograms starting at age 40. They are concerned these breast cancer screening recommendations by the USPSTF will result in unnecessary deaths and disfigurement due to latestage breast cancer detections.

Kremer, et al. (2012) carrying out a retrospective chart audit during one year’s time in a hospital compared women undergoing screening with women not receiving screening. Of the 108 primary breast cancers, 71 were found through mammography and 37 in the unscreened group. DCIS was more likely to be found in the group of women receiving mammography screening then those who received no screening. In addition, screened patients with invasive cancers were more likely to be diagnosed in earlier stages. The authors concluded by supporting screening mammography in women between the ages of 40 and 49 to detect cancers in earlier stages.

These authors support screening mammography in women between the ages of 40 and 49 to detect cancers in earlier stages.

 


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