by Ed Susman
Action Points
CHICAGO -- The addition of tomosynthesis to mammography provided better screening performance and lower recall rates, as well as higher invasive cancer detection in younger women, a researcher said here.
In women under age 50, recall rates for those undergoing conventional mammography was 115 per 1,000 cases compared with 108 per 1,000 cases for tomosynthesis (3D mammography), for a 6% reduction in recalls (P=0.013), reported Stephen Rose, MD, chief medical officer of Solis Mammography, a group of 30 clinics headquartered in Addison, Texas.
Also, cancer detection rates were 2.1 for mammography compared with 3.1 with the addition of tomosynthesis for a difference of 1.0 (P=0.021), while invasive cancer detection rates improved from 1.2 to 1.8 with the addition of tomosynthesis for difference of 0.8 (P=0.014), he said in a presentation at the Radiological Society of North America (RSNA) annual meeting.
This represented a relative increase in invasive cancer detection of 67%, he noted.
For the study, Rose examined the results of 65,457 screening examinations among women under age 50 -- 45,320 had conventional mammography and 20,137 underwent mammography plus tomosynthesis. The studies were done from Jan. 1, 2015 to Dec 31, 2015. Women screened with tomosynthesis plus mammography paid an out-of-pocket fee, Rose explained.
He also noted that "with tomosynthesis, we were able to find more cancers in women with dense breast tissue. In fact, using digital mammography we were unable to find any cancers in women with dense breast tissue."
Overall, the addition of tomosynthesis increased the positive predictive value (PPV) of the screening by more than 56%, Rose said.
Rose acknowledged that the study participants were not randomized, but that the findings do demonstrate a "real-world" way to approach to breast cancer screening in clinics.
The debate over screening women in their 40's for breast cancer is still an issue, with the U.S. Preventive Services Task Force suggesting that mammography screening should begin at age 50, and the American Cancer Society recommending that annual screening begin at age 45, but women can opt for screening starting at age 40.
But Rose noted that as many as 20% of invasive cancers are found in women under the age of 50, and breast cancer in these women are the cause of more life-years lost to the disease. "More aggressive, rapidly developing cancers are more likely in women diagnosed under the age of 50," he told MedPage Today.
Stamatia Destounis, MD, at the Elizabeth Wende Breast Clinic at the University of Rochester in Rochester, N.Y., told MedPage Today that tomosynthesis is going to find more cancers, more efficiently.
"This happens to me everyday," said Destounis, who was not involved in the study. "We look at the [conventional mammographic scan] and everything looks fine, and then when we start scrolling through the tomosynthesis scans, something pops up. The PPVs go up; the number of invasive cancers detected goes up; and the recall rate goes down."
But not all clinics are flocking to tomosynthesis, mainly due to costs, she noted. "There is the cost of getting rid of the current digital mammography unit, and the tomosynthesis units are more expensive to start with," she said.
In addition, exam room configurations will have to change "because the [tomosynthesis] unit is heavier; you may have to reinforce the floor. You will have to change the electrical supply. You will have to upgrade air conditioning because the room has to be kept cool, because the tomosynthesis units are sensitive to heat," she said.
And then there is the time factor. "No matter how proficient a radiologist gets at going through these [tomosynthesis] scans, you will never be as fast as you were when you just had a couple of digital scans to review," Destounis noted.
Rose disclosed relevant relationships with Hologic.
Destounis disclosed no relevant relationships with industry.
LAST UPDATED 11.29.2016
