By Jennifer Van Pelt, MA, Senior Research Analyst and Senior Hospital Consultant
An online article in last week’s USA Today reported on the controversies surrounding tomosynthesis, a new imaging technology that is Food and Drug Administration (FDA)-approved for breast imaging. If you haven’t seen it, it’s worth reading.
Also known as three-dimensional (3D) mammography, tomosynthesis uses a rotating x-ray tube and flat-panel detector to create 3D images of the breast. The technology is similar to that used for computed tomography (CT), but is an add-on to digital mammography systems. In comparison, digital mammography and traditional x-ray mammography create a 2-dimensional (2D) image of the breast. As a new technology, 3D mammography must be better than what’s already available, right? After all, it looks at the breast in 3 dimensions rather than 2. Unfortunately, sufficient evidence of comparative effectiveness isn’t available.
As the USA Today article points out, studies that have been conducted to date are too small to determine whether tomosynthesis will actually decrease the number of false-positive results that increase patient anxiety and require women to return for repeat imaging. Furthermore, studies of tomosynthesis in a routine screening setting are needed to assess the effects on improved detection versus unnecessary recalls. Another concern is the added radiation to which women who receive tomosynthesis are exposed.
The bottom line: we don’t know whether this new imaging technique will improve cancer detection compared with existing imaging modalities, or whether it will ultimately save women’s lives. Although it appears to be promising, and may be quite appropriate for certain women, at this point in time, we don’t have enough evidence. The lack of evidence hasn’t prevented providers from offering it to the 40 million women who undergo screening mammography each year.
There is no argument that early detection of breast cancer improves patient outcomes and saves lives. For now, however, we would advise women to speak openly with their physicians about tomosynthesis, ask questions about the technology, and review the evidence before undergoing the procedure. Such informed decision making will result in improved health outcomes for everyone.