Digital mammography for breast cancer screening

Digital mammography breast cancer screening of the future

03.10.2012

Digital mammography improves the early detection of breast cancer. Dutch researchers led by Adriana Bluekens from Radboud University in Nijmegen have compared breast cancer screening through "digital screening mammography" to traditional X-ray mammography.

In their study, the Dutch scientists come to the conclusion that aggressive breast cancer tumors based on digital mammography are better recognized than before. In addition, the original feared increase in the false-positive diagnoses did not occur, report Bluekens and colleagues in the journal "Radiology". The improved breast cancer screening also increases the chances of successful treatment of the tumors.

More than one million breast cancer screening evaluated
As part of their study, the researchers at Nijmegen's "National Expert and Training Center for Breast Cancer Screening" evaluated 1,198,493 screening tests from 2003 to 2007. Of the nearly 1.2 million breast cancer screenings, a total of 12.7 percent were performed with the help of digital technology, the rest were based on conventional X-ray film technology. In 18,896 patients, a follow-up examination was carried out on the basis of the first findings. The proportion of follow-up examinations in digital mammography was about twice as high as in conventional screening examinations. A total of 6,410 women were diagnosed with breast cancer using mammography. On the basis of X-ray film evidence was found in 5.6 out of 1,000 women in the initial examination, in 5.2 out of 1,000 patients confirmed the following tests the breast cancer diagnosis. The detection rate per 1,000 women in digital mammography was 6.8 at the first examination and 6.1 at the subsequent tests, according to Bluekens and colleagues.

No overdiagnosis due to digital mammography
As the Dutch researchers report, breast cancer screening not only has the goal of "discovering tumors as such", but must also enable an assessment of the associated breast cancer risk. Because not every tissue change in the breast has to develop into breast cancer. Thus, the procedures should identify only potentially aggressive premature forms, "everything else would be an overdiagnosis," write Adriana Bluekens and colleagues. Although a certain amount of overdiagnosis can not be ruled out in both breast cancer screening techniques, the digital procedure has no disadvantages in this respect. About the same number of slow-growing and thus harmless early breast cancer forms were discovered with both methods. The rate of false-positive diagnoses - contrary to previous fears - rise by switching to digital mammography. In both screening methods, the proportion of diagnoses of non-hazardous ductal carcinomas in situ (DCIS) was around three percent. "This result indicates that over-diagnosis by digital mammography in breast cancer screening does not increase," concludes the Dutch researchers.

Aggressive early forms of breast cancer reliably detected
With the aggressive forms of ductal carcinoma in situ, the discovery rate based on digital technology was significantly better than in conventional mammography, report Bluekens and colleagues. The rapidly growing, potentially invasive tumors were detected much more frequently. The invasive carcinomas could be detected particularly reliably by digital mammography, if they were associated with so-called microcalcifications (microscopic calcium deposits in the tissue). Overall, "digital mammography found significantly more tumors than conventional mammography," according to the results of the Dutch scientists.

Breast cancer screening saves lives
The study by the Dutch research team shows that there is room for improvement in breast cancer screening. The future belongs to digital technology. However, the traditional method has helped many women. The sooner breast cancer is detected, the better the chances of successful treatment. In this country, women between the ages of 50 and 69 are therefore invited to the mammography examination every two years. The costs are covered by her health insurance. While in Germany, the corresponding breast cancer screening program has only been running since 2006, this has already existed in the Netherlands for over twenty years. The Netherlands are also leaders in the introduction of digital breast cancer screening technology. (Fp)

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