• Tomosynthesis is a newer imaging modality:
  • That allows for reconstruction of planes from breast tissue volume:
    • Which overcomes the limitations of 2-dimensional imaging caused by overlapping normal and pathologic breast tissue
• Tomosynthesis has been shown to increase the detection of invasive cancer:
  • By more than a third compared with 2D mammography alone and reduces false-positive results by 15%
• Screening mammography does reduce mortality:
  • Pooled estimates from multiple trials demonstrate a reduction of 20%
• MRI is recommended for screening in high-risk women:
  • High-risk is defined as:
    • A lifetime risk of 20%
• There is a national trend toward adopting legislation:
  • That requires the reporting of breast density to women undergoing mammography:
    • As well, there is a need for supplemental screening for this group of women with dense breasts
  • Automated ultrasound may be a good alternative for these patients:
    • In one study of patients with 50% breast density, automated ultrasound detected 12.3 cancers per 1,000 breast cancers compared with 4.6 per 1,000 by mammography alone
• Imaging with all three modalities has not been validated
• References:
  • Friedewald SM, Rafferty EA, Rose SL, et al. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA.
  • Giuliano V, Giuliano C. Improved breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. Clin Imaging. 2013;20:480-
  • Smith RA, Duffy SW, Gabe R, Tabar L, Yen AM, Chen TH. The randomized trials of breast cancer screening: what have we learned? Radiol Clin North Am. 2004;42:793-806.486.2014;311:2499-2507.
  • Smith RA, Duffy SW, Gabe R, Tabar L, Yen AM, Chen TH. The randomized trials of breast cancer screening: what have we learned? Radiol Clin North Am. 2004;42:793-806.

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