Digital Breast Tomosynthesis and the Cancer Screening Debate

Breast tomosynthesis has become one of the increasingly popular options for cancer screenings in women today. The medical imaging procedure can provide physicians with comprehensive, three-dimensional scans of the breast tissue for more in-depth review of density and instances of cancer risk factors, such as abnormal growths.

According to Diagnostic Imaging, an article recently published in the Journal of the American College of Radiology discussed the frequent – but limited – use of digital breast tomosynthesis in the medical practice. Led by Lara Hardesty, M.D., researchers from the University of Colorado in Aurora reviewed the usage and criteria for offering the procedure to patients. For the report, the team surveyed physician members of the Society of Breast Imaging, who filled out an online form asking questions about their utilization of digital breast tomosynthesis.

The researchers were looking for information on clinical decision rules regarding patient selection for the scan as well as the associated costs, and if the practices were making any plans to obtain digital tomosynthesis equipment. Additionally, the survey inquired about the procedure’s availability at certain locations, the characteristics of the practice itself and if the digital imagingprocess was used for care or clinical research. The questionnaire had a 37 percent response rate from roughly 670 participants.

Out of the respondents, 200 physicians stated that they used tomosynthesis – of those, nearly 90 percent used it in a clinical care setting.

“Criteria used to select patients to undergo DBT varied, with 107 (68.2 percent) using exam type (screening versus diagnostic), 25 (15.9 percent) using mammographic density, and 25 (15.9 percent) using breast cancer risk,” wrote the authors, quoted by the news source.

From their findings, the researchers determined that although digital breast tomosynthesis is being used more often in practices, clinical guidelines could help in further adoption of the imaging equipment. Rules could also facilitate standardizing the justification of utilizing tomosynthesis.

Breast cancer screening debate redo
According to papers published in the Annals of Internal Medicine, the various participants involved in the cancer screening argument need to rehash their approaches to the issue to find new ways to solve the problem, AuntMinnie.com reported.

Russell Harris, M.D., from the University of North Carolina, felt that breast screening was only part of the solution to cancer but that more needs to be done to improve health outcomes.

“Breast cancer is a terrible scourge, and all of us would like to get rid of it. But the burden it places on our society goes beyond the cancer itself to include false positives, over​diagnosis, and the general fear the disease inspires. I suggest that our attention should be drawn to addressing and reducing this overall burden,” he said, quoted by the news source.

Essentially, screening should not be viewed as the end-all solution to preventing, diagnosing and treating cancer in women. Health care providers have to look at the big picture of breast cancer and encourage more lifestyle changes in patients, such as increasing cardiovascular exercise and avoiding alcohol. While procedures such as breast tomosynthesis can be beneficial, these kinds of screenings can lead to overdiagnos​is and false positives.

Rather than develop and adopt new diagnostic radiology procedures, physicians should look to expand their efforts to improve treatment by including lifestyle changes for women. By informing patients of their health status, doctors can encourage collaborative decision-making on clinical scans and determine if multiple screenings are necessary.

The need for change is clear, but digital tomosynthesis may be the answer that Harris – and at-risk women everywhere – is looking for in cancer screening and diagnosis.

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