Mammography is the gold standard for screening in the detection of early breast cancer, since it has proven to reduce mortality by 44%. The efficacy of mammography depends on the technical quality of the mammogram, the expertise of the interpreting radiologist, and proper implementation of a screening program. Mammography relies on the relative densities of breast tissues to differentiate normal from abnormal tissue. Breast density is the most significant independent predictor of sensitivity at any age; fatty breast 98% and very dense breast 48%. The overall mammographic sensitivity is 85% but decreases to 45% in women with dense breast tissue, breast implants or in the post surgical breast. In general, sensitivity is lower in women under 49 years old of age.
Compared to screen film mammography (SFM), digital mammography (DM) exposes patients to slightly lower doses of radiation, while optimizing the image contrast. DM improves the sensitivity of breast cancer detection from 55% to 70% in women less than 50 years (pre or peri-meopausal) with dense breast. However, DM is significantly more expensive than SFM. The equipment costs approximately $400,000 versus $100,000 plus higher expenses for maintenance, storage and retrieval.
Studies have shown that a second mammography reader can increase the number of cancers detected by 4-14% without changing the false positive rates. However, this added cost is not reimbursed and therefore is impractical in most practices. Computed-aided- detection or CAD achieves the same detection rate as two readers and increases the sensitivity (especially for microcalcifications), but is not as effective for masses. However the improved sensitivity with CAD is offset by both an increase in false positives and biopsy rates.
1. Skaane P, Bandos AI, Gullien R, et al. Comparison of digital mammography alone and digital mammography plus tomosynthesis in a population-based screening program. Radiology. 2013 Apr;267(1):47-56.
2. Zuley ML, Guo B, Catullo VJ, Chough DM et al. Comparison of Two-dimensional Synthesized Mammograms versus Original Digital Mammograms Alone and in Combination with Tomosynthesis Images. Radiology. 2014 Jun; 271(3):664-71.
3. Skaane P, Bandos AI, Eben EB, et al. Two-View Digital Breast Tomosynthesis Screening with Synthetically Reconstructed Projection Images: Comparison with Digital Breast Tomosynthesis with Full-Field Digital Mammographic Images, Radiology. 2014 Jun;271(3):655-63.
4. Gur D, Zuley ML, Anello MI, et al. Dose reduction in digital breast tomosynthesis (DBT) screening using synthetically reconstructed projection images: an observer performance study. Acad Radiol. 2012 Feb;19(2):166-71.
5. Ciatto S, Houssami N, Bernardi D, et al. Integration of 3D digital mammography with tomosynthesis for population breast-cancer screening (STORM): a prospective comparison study. Lancet Oncol 2013; 14: 583–89.
6. Durand MA, Haas BM, Yao X, et al. Early Clinical Experience with Digital Breast Tomosynthesis for Screening Mammography. Radiology, 2015 Jan, 274: 85–92.
7. Haas BM, Kalra V, Geisel J et al. Comparison of Tomosynthesis Plus Digital Mammography and Digital Mammography Alone for Breast Cancer Screening, Radiology, 2013, Dec, 269: 694–700.
1. Fletcher SW, Elmore JG. Mammographic screening for breast cancer. N Engl J Med 2003; 348: 1672-80.
2. Smith-Bindman R, Chu P, Miglioretti DL et a. Physician predictors of mammographic accuracy. J Natl Cancer Inst 2005; 97: 358-67.
3. Buist DSM, Porter PL, Lehman C, Taplin SH, White E. Factors contributing to mammography failure in women aged 40-49 years. J Natl Cancer Inst 2004; 96: 1432-40.
4. Carney PA, Miglioretti DL, Yankaskas BC et al. Individual and combined effect of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med 2003;138: 168-75.
5. Pisano ED, Gatsonis C, Hendrick E et al. Diagnostic Performance of Digital versus Film Mammography fro Breast-Cancer Screening. N Engl J Med 2005; 353: 1056-67.
6. Hambly NM, McNicholas MM, Phelan N et al. Comparison of Digital Mammography and Screen-Film Mammography in Breast cancer Screening: A review in the Irish Breast Screening Program. Ann J Roentgenol AJR 2009; 193:1010-18.