3D Mammography Improves Cancer Detection in Women Under Age 50

The addition of tomosynthesis to mammography provided better screening performance and lower recall rates, as well as higher invasive cancer detection in younger women, based on a recent study.

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 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, while invasive cancer detection rates improved from 1.2 to 1.8 with the addition of tomosynthesis, 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. 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.

Bottom line: 3D tomosynthesis mammography improves cancer detection in women under the age of 50. Tomosynthesis is more effective in dense breast tissue which is more prevalent in women under the age of 50.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Breast Tomosynthesis Technique May Help Reduce Breast Cancer Screening Recall Rate

A new digital breast tomosynthesis technique has the potential to reduce the rate at which women are called back for additional examinations without sacrificing cancer detection, according to a study published in Radiology.

Digital breast tomosynthesis (DBT) in conjunction with full-field digital mammography (FFDM) has been shown to improve cancer detection and reduce callbacks for additional examinations. However, the combination of the two methods requires a second radiation exposure to the breast and also slightly more time for women in breast compression. Researchers at Christiana Care Health System developed a DBT technique that may eliminate the need for FFDM.

Researchers have been exploring a relatively new approach in which the DBT images are used to create a synthesized 2-D (s2D) compilation image. The method has the potential to render FFDM unnecessary. Investigators compared the clinical performance of DBT-s2D with that of DBT-FFDM and FFDM alone. They studied 78,810 screening mammograms performed from 2011 to 2016. In the study group, 32,076 women were screened with FFDM, 30,561 women were screened using DBT-FFDM, and 16,173 women were screened using DBT-s2D.

The study demonstrated that DBT-s2D’s recall rate was only 4.3% compared with 5.8% for DBT-FFDM. Overall cancer detection rates were similar. However, DBT-s2D detected 76.5% of invasive cancers compared with 61.3% for DBT-FFDM. At 3.6%, the false ̶positive rate for DBT-s2D was significantly lower than the 5.2% rate for DBT-FFDM. The positive predictive value of biopsy for DBT-s2D was 40.8% compared to 28.5% for DBT-FFDM.

Dr Jacqueline Holt, director of Breast Imaging at Christiana Care Health System said: “The adoption of s2D mammography combined with DBT into screening programs would limit radiation exposure to the patient, and, on the basis of our results, may improve clinical performance.”

Bottom line: Advanced imaging techniques such as 3D tomosynthesis with synthesized 2D images have the potential to reduce radiation exposure and improve breast cancer detection when compared to stand-alone 2D full field digital mammography or the combination of 2D full field digital mammography with 3D tomosnthesis mammography.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Exercise is an Important Key to Preventing Breast Cancer Recurrence

For women who have recovered from breast cancer, exercise appears to be the most important lifestyle choice to reduce the risk of death from a relapse. The research involved a review of 67 published articles and recently published in the Canadian Medical Association Journal.

“Of all lifestyle factors, physical activity has the most robust effect on breast cancer outcomes,” co-author Ellen Warner, of Sunnybrook Health Sciences Center in Toronto, said in a press release. “Weight gain of more than 10% body weight after a breast cancer diagnosis increases breast cancer mortality and all-cause mortality. However, there are good reasons to discourage even moderate weight gain because of its negative effects on mood and body image.”

The authors looked at lifestyle factors such as exercise, weight, diet, and smoking to determine what behaviors women can change to improve their chances of surviving a recurrence of breast cancer.

They conclude that physical activity can reduce the chance of death from a breast cancer relapse by up to 40 percent. Specifically, researchers recommended engaging in at least 30 minutes of moderate exercise five days a week or 75 minutes of vigorous exercise per week, as well as core muscle strength training. Another suggestion was eating a healthy and nutritious diet. The research team noted that no diet is known to reduce the risk of breast cancer, so patients should follow general diet recommendations.

It is hard to isolate why exercise confers such benefits, says Warner, but one possible explanation is that it suppresses inflammation that could otherwise damage cells and increase the risk of cancer spreading. A key recommendation was avoiding weight gain, since it is linked to decreased chance of survival. Another important recommendation was exercising more. As for taking vitamin supplements, researchers recommended vitamin C because it helps maintain bone strength. Chemotherapy and hormone treatments are known to reduce bone density. Breast cancer patients should also stop smoking immediately, and limit their alcohol intake to one drink a day.

“Because it is common for patients to reduce their level of physical activity after a breast cancer diagnosis, it is important for health care professionals to promote and encourage exercise in this patient population,” the authors added. “Simply receiving advice from an oncologist to exercise more has been shown to increase patients’ level of activity.”

It is important to note that patients included in these studies were not only changing their behaviors, they were also receiving conventional anti-cancer therapy. Lifestyle changes alone should not be used in place of adequate treatment under the supervision of a breast cancer specialist.

The authors stressed that their recommendations may not work for everyone with a breast cancer diagnosis because some cancers are more aggressive and may recur despite the most carefully followed lifestyle regimen.

Bottom line: An active lifestyle combined with a healthy diet can reduce the risk of breast cancer recurrence. The combination of a healthy diet and physical activity have been linked to a reduction in mortality from numerous diseases.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.