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Breast tomosynthesis may prove superior to mammogram

While mammography is still the gold standard for breast cancer screening, a new technology is on the horizon that promises to be better.

Tomosynthesis improves upon the mammogram by providing multiple 3-D images. The images that are taken allow doctors to see the entire breast.

Administered like a mammogram, with a woman’s breast compressed, tomosynthesis takes images in a limited arc. The radiation is similar to mammography.

Better technology for seeing the entire breast
When the tomosynthesis images are looked at all together, it’s like turning the pages of a book, and doctors can better reconstruct the entire breast.

Sometimes on a mammogram, dense tissue in the breast could be superimposed, making it difficult to determine if something is cancer. Cancers can also be hidden. It is during these situations that women are called back for additional X-ray views. This can be very upsetting for women, who fear that they may have breast cancer. Fact is, call-backs are very common, with 10 percent of all women needing additional views taken. In addition to cancers being superimposed, some women have denser breasts, which may require additional views.

Same radiation as mammogram
It is hoped that tomosynthesis will pick up more instances of cancer. Mammography misses about 10 percent of early breast tumors. Tomosynthesis is administered the same way a mammogram is given, with a woman standing up with her breast compressed. It takes about 10 seconds, longer than a standard mammogram image, because it is taking more views, but the radiation exposure is no more than a routine X-ray.

The Yale-New Haven Hospital study will enroll 250 women who have not had prior breast cancers. Each of the participants will get both a tomosynthesis study and a mammogram.

We will then see if the tomosynthesis detected more instances of cancer than mammogram alone. Based on the study done at Dartmouth University in 2005, I’m hoping that this will be the case. The Dartmouth study found that the tomosynthesis was superior to mammogram in 37 percent of the cases. It also reduced the recall rate by 40 percent.

This would be great news for women, since mammograms aren’t 100 percent effective.

To reduce use of MRI
Tomosynthesis may also reduce the number of times women need an MRI (magnetic resonance imaging) to get a better look at a suspicious breast tumor.

Now, women with prior breast cancers, who are high risk, are newly diagnosed, or who have breast implants, often need an MRI. MRI is a more complex and involved process, and the ease of tomosynthesis may reduce the need for MRI.

Our study should take four to six months to enroll patients and six to 10 months until the results are known. As the principal investigator for Yale-New Haven Hospital, I will be excited to report back on our results. It is hoped that this test will make a world of difference for women getting mammograms.

Dr. Philpotts is the chief of Breast Imaging at Yale-New Haven Hospital, and associate professor of Diagnostic Radiology and vice chair of Clinical Affairs at the Yale University School of Medicine.