In the largest such study to date, researchers have found that breast cancer screening using a combination of traditional 2D digital mammography and 3D imaging detects more invasive breast cancers and reduces false alarms compared with traditional mammography alone.

Adding 3D imaging to traditional digital mammography finds more invasive breast cancers and reduces false positives, a new study finds, although it is not yet known whether the new technology improves breast cancer survival.

Researchers retrospectively reviewed 454,850 mammograms from 13 breast centers. More than a third used 3D imaging, or digital breast tomosynthesis, done at the same time as traditional mammography, whereas the rest used traditional mammography alone.

The 3D mammography image on the right reveals a 15 mm mass (circled), which is hidden in the traditional digital image on the left.

The 3D mammography image on the right reveals a 15 mm mass (circled), which is hidden in the traditional digital image on the left.

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The invasive cancer detection rate increased from 2.9 per 1,000 traditional mammograms to 4.1 per 1,000 combined 3D mammograms, researchers reported (JAMA 2014;311:2499–507). False positives were 15% less likely using the 3D approach, and there were 16 fewer callbacks for additional imaging per 1,000 screenings.

“Conventional mammography is far from ideal,” says senior author Emily Conant, MD, chief of breast imaging at the University of Pennsylvania's Perelman School of Medicine in Philadelphia. “3D mammography is an improvement because it addresses two of the major limitations of mammographic screening—there are too many false positives and the sensitivity is not what we'd like, so we miss cancers.”

The FDA approved the Selenia Dimensions digital breast tomosynthesis system (Hologic; Bedford, MA) in 2011 in combination with traditional mammography for breast cancer screening. Using multiple low-dose X-rays taken at different angles, thin “slices” of breast tissue are reconstructed into a 3D image that gives a clearer view of breast tissue.

In an accompanying editorial, Etta Pisano, MD, and Martin Yaffe, PhD, called for more research, noting that it is still uncertain whether tomosynthesis should replace traditional digital mammography (JAMA 2014;311:2488–9).

Conant notes that because the study was not designed to follow women over time, it is not known whether 3D mammography saves lives. It is also unclear which women benefit the most from 3D scans, she says.

“We need research that looks at patient-level data such as breast density, patient age, and the types of cancer detected with 3D mammography that weren't detected with conventional mammography,” Conant says. “We need to better understand what each woman needs.”

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