Where the technique may prove most useful is for younger women who have dense breasts that make it harder for X-rays to reveal tumors, which are also dense. Five states have passed laws requiring radiologists to inform a woman if she has dense breasts and direct her to ask her doctor whether she needs additional screening or more frequent breast exams.
While Massachusetts doesn’t have such a requirement, women like Judith Romano, of Ashland, are often told they have dense breasts, which not only puts them at higher risk of breast cancer but also leads to more frequent callbacks for ambiguous findings. Romano had several anxiety-provoking callbacks during her early 40s until she opted to have a 3-D mammogram when it became available last year at Mass. General, where she works as an executive assistant.
“The regular mammogram showed nothing, but the 3-D image found something suspicious,” said the 50-year-old mother of two. A biopsy revealed cancer, which led her to have a double mastectomy along with reconstruction after the initial surgery revealed more cancer cells than originally anticipated.
“My wish is for all women to be empowered with access to the best technology for detection in the early stages,” Romano said. “I’m not clairvoyant, but I do believe it was a lifesaver for me.”
Hologic has turned that sentiment into a sales pitch for a digital and print ad campaign it launched last month declaring that “smart women demand 3-D mammography.” The ad cites small studies — presented at research conferences but not yet published in medical journals — and declares that the technology provides a more accurate picture of the breast, “significantly improving early detection.”
But one researcher, whose study the ad cites, criticized the campaign for overselling an imaging device that’s very new and without a proven track record.
“I think they’re making it sound too dramatic,” said the researcher, Dr. Liane Philpotts, chief of breast imaging at Yale Medical Center, who has studied breast tomosynthesis with funding from Hologic. “To show improved cancer detection will take a lot more study.”
In data collected on nearly 5,800 women that will be presented at a radiology conference later this month, Philpotts found that 10 percent of women who had just the standard imaging had to come back for a repeat X-ray compared with 6 percent of those who had both the standard and 3-D mammography.
About one-third of the patients who were recalled went on to have a biopsy, which more often than not comes back without any sign of cancer. While 3-D mammograms lower the likelihood of vague-looking findings that require additional imaging, they haven’t been shown to lower the detection of suspicious looking findings such as calcifications that require biopsies — which usually turn out to be benign. The high rate of benign biopsies is considered one of the major drawbacks of standard 2-D mammography.
“I don’t think 3-D mammography will have a profound effect on reducing the number of biopsies,” Philpotts said. “If anything, it might increase the rate since it finds more cancers” as well as high-risk breast lesions that require removal before they become cancerous.
Whether 3-D mammography will reduce a woman’s risk of dying from breast cancer more than regular mammograms isn’t yet known. A controversial study published in the New England Journal of Medicine a few weeks ago indicated that, while mammography has saved some women’s lives because of early detection, as many as 30 percent of women whose breast cancers are detected on regular mammography have slow-growing cancers that wouldn’t have otherwise been diagnosed and would never have become life-threatening.
Having a 3-D screening tool that detects even more breast cancer might simply amplify the trade-offs of mass cancer screening. It could wind up increasing the small number of women whose lives are saved by early detection via mammography by a little bit, while increasing the number of women treated for non-aggressive cancers a lot more, according to study coauthor Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute of Health Policy and Clinical Practice in Hanover, N.H.
The American Cancer Society has no immediate plans to alter its guidelines to specifically state that women should have 3-D mammography instead of “yearly mammograms . . . starting at age 40” as is currently recommended, said Robert Smith, director of the society’s cancer screening program. “But in the future,” he said, “we hope to see data to allow us to tailor imaging recommendations specific to a woman’s needs.”Continued...