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Digital Mammography Helps Find Cancer in Dense Tissue

Breaking News - September 2005 - Week 3

(Sep 21, 2005)

Healthcare in  the News

-- Compared with standard mammograms, which are recorded on film, computer-based digital mammograms are more accurate for more than half the women who get the breast cancer screenings, according to a report in the New England Journal of Medicine (NEJM).

Picture of a woman at her desk

Younger women with dense breast tissue, those under 50, and those who are premenopausal would benefit from having digital mammograms, the researchers reported.

The findings, which will appear in the Oct. 27 issue of the NEJM, were released early to coincide with a presentation at the fall meeting of the American College of Radiology Imaging Network (ACRIN). The study was supported by the National Cancer Institute (NCI) and ACRIN.

"These results will give clinicians better guidance and greater choice in deciding which women would benefit most from various forms of mammography," says lead author Dr. Etta D. Pisano, a professor of radiology and biomedical engineering at the University of North Carolina School of Medicine.

An estimated 211,240 women will be diagnosed with breast cancer in the US this year, making it the most commonly diagnosed cancer in women, states the NCI. An estimated 40,410 women will die of the disease this year in the US.

Women with Dense Tissue, Younger Women Benefit

In the new study, Dr. Pisano and her colleagues in the Digital Mammographic Imaging Screening Trial (DMIST) collected data on 49,528 asymptomatic (without symptoms) women screened for breast cancer. The women underwent both digital and film mammography. The researchers were able to evaluate data for 42,760 women.

"Overall, film and digital mammography were equally accurate," Dr. Pisano explains. "But for women with dense breasts, women under age 50, and women who were pre- and perimenopausal, digital was significantly better."

Dr. Pisano believes that, particularly for these women, digital mammograms are important.

"For the 65 percent of women who had improved accuracy, they should get that kind of mammography," she says. "But for other women, there is no benefit of digital over film, and it's more expensive."

Dr. Pisano states that for most women who get mammograms - those past menopause with fatty breasts - "there's no reason to seek digital," because "film is just as good."

However, Dr. Pisano adds that although digital mammography makes up only about 8 percent of the market today, it will eventually replace film mammography.

"There is a trend toward digital, mainly for the other advantages that it offers," she notes.

These advantages include the ease of storing and retrieving digital images, and making them part of a patient's electronic medical record.

"If you have dense breasts, if you are under 50, if you're pre- or perimenopausal, you should receive a digital mammogram," Dr. Pisano advises. "It is important that women get screened when they are supposed to be screened and not wait to get a digital - if there is film available it's better than nothing."

Digital Is the Future, Experts Say

One expert sees digital mammography as the future of breast cancer screening.

"Even without a clinical benefit, digital would replace film," says Dr. Rowan T. Chlebowski, a medical oncologist at Los Angeles BioMedical Research Institute. "With the current mandate for electronic medical records, you are going to have a hard time getting a film mammogram into an electronic medical record."

"Just the way we handle information, it's the future anyway," Dr. Chlebowski says. "But this study makes it more reasonable to go for the investment now, because you get an immediate clinical payoff."

Another expert stressed that women need to get screened for breast cancer, and not wait for digital screening if it is not available in their area.

"The finding that digital mammography is more accurate than film mammography in women under age 50 and women with medium and high breast density … it is an important finding that should lead to improvements in screening programs - if digital mammography is targeted to women who are likely to benefit the most," says Dr. Robert A. Smith, director of cancer screening for the American Cancer Society.

However, even though the availability of digital mammography is increasing, it is still limited, and it is unclear how soon or whether it will entirely replace film mammography, he adds.

"The important thing is that women receive mammograms on a regular basis, regardless which technology they use," Dr. Smith says. "Younger women and women with denser breasts should not forego their regular mammogram if digital mammography is not available.

"While this study showed an advantage with digital imaging in these groups, it should be remembered that traditional film mammography also is effective," Dr. Smith says.

According to Dr. Andrew C. von Eschenbach, NCI director, “This digital mammography study demonstrates how new technologies are expanding our ability to detect breast cancer earlier in more women.

"The study corroborates NCI’s commitment to exploring advanced technologies in a wide range of clinical applications and the critical role they can play in making cancer a manageable disease,” he says.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.

NCI on Digital Mammography

According to the NCI, both digital and film mammography use X-rays to produce an image of the breast.

In film mammography, which has been used for over 35 years, the image is created directly on a film. While standard film mammography is very good, it is less sensitive for women who have dense breasts.

Prior studies have suggested that approximately 10 percent to 20 percent of breast cancers that were detected by breast self-examination or physical examination are not visible on film mammography.

A major limitation of film mammography is the film itself. Once a film mammogram is obtained, it cannot be significantly altered; if the film is underexposed, for example, contrast is lost and cannot be regained.

Digital mammography takes an electronic image of the breast and stores it directly in a computer. Digital mammography uses less radiation than film mammography.

Digital mammography allows improvement in image storage and transmission because images can be stored and sent electronically.

Radiologists also can use software to help interpret digital mammograms.

One of the obstacles to greater use of digital mammography is its cost, with digital systems currently costing approximately 1.5 to 4 times more than film systems.

For women, breast cancer is the most common non-skin cancer and the second leading cause of cancer-related death in the US.

Death rates from breast cancer have been declining since 1990, and these decreases are believed to be the result, in part, of earlier detection and improved treatment.

The Digital Mammographic Imaging Screening Trial (DMIST) was performed to measure relatively small, but potentially clinically important, differences in diagnostic accuracy between digital and film mammography.

While any differences that were detected might be relatively small, they could improve breast cancer detection for all or some groups of women.

Digital mammography is a newer technology that is becoming more common. Currently, approximately 8 percent of breast imaging units provide digital mammography.

Past trials of digital mammography have shown no difference in diagnostic accuracy between digital and film mammography.

The US Food and Drug Administration (FDA) trials and three smaller screening trials showed no significant difference in the performance of digital mammography vs. film mammography.

These studies were limited, however, because they each included only one type of digital detector and had a relatively small numbers of patients, perhaps limiting their ability to detect small differences in diagnostic accuracy.

Always consult your physician for a diagnosis.

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