Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | June 26, 2015

JAMA Study Boosts Credibility of Screening Mammo

Call-backs have always been a problem in mammography. They are a source of worry, added discomfort, well-founded patient complaints about the inefficiency of breast exams, and unnecessary cost. More than that, they call into question the credibility of an exam whose use depends on women’s belief in its value.

 

Now a study, published June 25 issue of the Journal of the American Medical Association (JAMA), has found that the addition of 3-D imaging, widely known as breast tomosynthesis, substantially decreases the proportion of patients who are called back, just as its use finds more cancers than the use of 2-D digital mammography alone — a 41 percent increase in the detection of invasive breast cancers and a 29 percent increase in the detection of all breast cancers.
 
While the data indicating improved performance due to the use of breast tomo is welcome, they come as no surprise. The FDA approved the sale of 3-D imaging systems for breast cancer screening in 2011 because studies showed its addition to standard digital mammography uncovers more cancers, just as it reduces false positives. Its effect on recall rates, however, has been largely anecdotal. The just published JAMA study changes that. 
 
Data acquired at 13 U.S. centers performing 454,850 screening exams (61 percent of which involved only 2-D digital mammography for comparison) found that the addition of tomo dropped the recall rate from 107 to 91 per 1,000 screening exams — a 15 percent decrease. This translates to 16 fewer recalls per 1,000 screening exams. 
 
The study is good news for women in general and Hologic in particular. The company’s Selenia Dimensions is the only breast tomography system currently approved by the FDA for sale in the United States. More than 1,000 of these systems are operating across all 50 states, according to the company, including those at the five academic hospitals and eight community-based sites participating in the study. 
 
Hologic framed the study as addressing the two most frequently cited concerns about breast cancer screening — unnecessary recalls and finding cancers that do not need to be treated. The latter was demonstrated by the 41 percent increase in the detection of invasive breast cancers; the former by a double digit reduction in the recall rate.  
 
It’s hard to overestimate the importance of these findings. Screening mammography  exposes women with no known sign of disease  to ionizing radiation, which itself can cause cancer. As such, they deserve the greatest possible assurance that the exam they undergo is done with the least chance of being wrong. The JAMA study documents that the routine use of tomosynthesis in breast cancer screening does exactly this, providing women the reason to believe that modern mammography truly is a potentially life-saving tool. 
 

Related Content

Radiologists have recently taken on the role of activists and are tackling pressing issues in healthcare, including breast density

Getty Images

Feature | Women's Health | January 20, 2021 | By Fazila Seker, Ph.D.
Radiologists — who have long been professionals in the metaphorical and literal back-rooms of healthcare — have recen
Novel Coronavirus SARS-CoV-2 Transmission electron micrograph of SARS-CoV-2 virus particles, isolated from a patient. Image captured and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. Credit: National Institute of Allergy and Infectious Diseases, NIH

Novel Coronavirus SARS-CoV-2 Transmission electron micrograph of SARS-CoV-2 virus particles, isolated from a patient. Image captured and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. Image courtesy of  National Institute of Allergy and Infectious Diseases (NIH)

News | Coronavirus (COVID-19) | January 15, 2021
January 15, 2021 — In one of the first studies to examine the impact of the...
A, Contrast-enhanced axial T1-weighted fat-saturated image from baseline MRI before initiation of neoadjuvant therapy shows irregular mass (arrow) in upper inner right breast corresponding to biopsy-proven carcinoma. B, Contrast-enhanced axial T1-weighted fat-saturated image from follow-up MRI performed 3 months after initiation of neoadjuvant therapy shows decrease in size of right breast cancer (arrow). C, Contrast-enhanced axial T1-weighted fat-saturated image 3 months after initiation of neoadjuvant the

A, Contrast-enhanced axial T1-weighted fat-saturated image from baseline MRI before initiation of neoadjuvant therapy shows irregular mass (arrow) in upper inner right breast corresponding to biopsy-proven carcinoma. B, Contrast-enhanced axial T1-weighted fat-saturated image from follow-up MRI performed 3 months after initiation of neoadjuvant therapy shows decrease in size of right breast cancer (arrow). C, Contrast-enhanced axial T1-weighted fat-saturated image 3 months after initiation of neoadjuvant therapy shows new mass (arrow) in upper outer left breast that was assessed as BI-RADS 4. Pathologic examination from MRI-guided core biopsy of new suspicious mass revealed benign usual ductal hyperplasia. No atypia or malignancy was identified. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

News | MRI Breast | January 15, 2021
January 15, 2021 — According to ARRS' ...
A targeted intervention providing mammograms to hospitalized Medicaid patients can help patients complete overdue breast cancer screening

Getty Images

News | Mammography | January 14, 2021
January 14, 2021 — Completing cancer screening tests, such as...
DB-I website features new educational tools and streamlined user experience to improve access to medically sourced breast density content
News | Breast Density | January 13, 2021
January 13, 2021 — DenseBreast-info.org (DB-I) invites he
This cutting-edge technology assists radiologists in the interpretation of screening mammograms and allows them to diagnose breast cancer earlier and more accurately
News | Mammography | January 12, 2021
January 12, 2021 — Therapixel announced that...